Differential Diagnosis for Acute Abdominal Pain in a Patient with Asthma Exacerbation

• Single most likely diagnosis:
  • Gastroesophageal reflux disease (GERD) exacerbation: This is a common comorbidity in asthma patients, and the abdominal pain could be related to GERD symptoms worsening due to increased intra-abdominal pressure from coughing or mechanical ventilation.
• Other Likely diagnoses:
  • Pneumonia or pneumothorax causing referred abdominal pain: Asthma exacerbations can increase the risk of respiratory complications, which might refer pain to the abdomen.
  • Medication side effects (e.g., steroids, bronchodilators): Certain medications used to treat asthma can cause gastrointestinal side effects, including abdominal pain.
  • Stress-induced gastritis or peptic ulcer disease: The stress of an acute asthma exacerbation could lead to gastrointestinal complications.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Pulmonary embolism with referred abdominal pain: Although less common, pulmonary embolism is a life-threatening condition that can present with abdominal pain in the context of a respiratory condition like asthma.
  • Cardiac ischemia or myocardial infarction: Patients with asthma are at increased risk of cardiovascular events, and cardiac ischemia can sometimes present with abdominal pain.
  • Ruptured viscus or bowel obstruction: These are rare but life-threatening conditions that could present with acute abdominal pain and require immediate surgical intervention.
• Rare diagnoses:
  • Eosinophilic gastroenteritis: A rare condition associated with eosinophilia and gastrointestinal symptoms, potentially linked to asthma.
  • Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis): A rare autoimmune condition that can cause both asthma and abdominal pain due to vasculitis.