Differential Diagnosis
The patient presents with abdominal pain, a history of GI bleed, and various laboratory and imaging findings. The following differential diagnosis is organized into categories:
- Single Most Likely Diagnosis
- Peptic Ulcer Disease (PUD): The CT abdomen suggests PUD as the most likely diagnosis, given the patient's history of GI bleed and the presence of abdominal pain. The laboratory findings, including anemia (indicated by low hemoglobin and hematocrit) and elevated WBC count, also support this diagnosis.
- Other Likely Diagnoses
- Duodenal Diverticulitis: Although less likely than PUD, duodenal diverticulitis is still a possible cause of the patient's symptoms, especially given the CT findings of inflammatory changes in the descending duodenum.
- Urinary Tract Infection (UTI): The urinalysis results show evidence of a UTI, including positive nitrite, leukocyte esterase, and the presence of bacteria and yeast. This could be contributing to the patient's overall clinical presentation.
- Nephrolithiasis: The probable tiny stones in the bladder lumen, as seen on the CT, could be causing or contributing to the patient's symptoms, including abdominal pain and hematuria.
- Do Not Miss Diagnoses
- Bleeding Disorder or Coagulopathy: Given the patient's history of GI bleed, it is essential to consider a bleeding disorder or coagulopathy, which could be exacerbating the patient's condition.
- Sepsis: Although the patient's procalcitonin level is low, the presence of a UTI and elevated WBC count necessitates consideration of sepsis, especially if the patient's condition worsens.
- Obstructive Uropathy: The presence of probable tiny stones in the bladder lumen and hematuria raises the possibility of obstructive uropathy, which could lead to severe consequences if not addressed promptly.
- Rare Diagnoses
- Duodenal Cancer: Although rare, duodenal cancer could present with similar symptoms and findings, including abdominal pain, GI bleed, and a mass or inflammatory changes on imaging.
- Vasculitis: Certain types of vasculitis, such as Henoch-Schönlein purpura, could present with abdominal pain, GI bleed, and renal involvement, making it a rare but possible diagnosis to consider.