Differential Diagnosis for Upper Abdominal Pain, Nausea, and Vomiting in an 87-year-old Female

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD) or Peptic Ulcer Disease: These conditions are common in the elderly and can cause upper abdominal pain, nausea, and vomiting, especially after eating. The age and symptoms of the patient align with these diagnoses.

Other Likely Diagnoses

• Gallbladder Disease (Cholecystitis or Cholelithiasis): Gallstones are more common in women and increase with age. Symptoms can include upper abdominal pain, nausea, and vomiting, especially after fatty meals.
• Gastritis: Inflammation of the stomach lining can cause upper abdominal pain, nausea, and vomiting. It can be acute or chronic and is common in the elderly.
• Constipation: Although not typically thought of as a cause of upper abdominal pain, severe constipation can cause nausea, vomiting, and referred pain to the upper abdomen in elderly patients.

Do Not Miss Diagnoses

• Myocardial Infarction: Although more commonly associated with chest pain, myocardial infarctions can present atypically in the elderly with symptoms such as upper abdominal pain, nausea, and vomiting.
• Pulmonary Embolism: Similar to myocardial infarction, pulmonary embolism can present with atypical symptoms in the elderly, including upper abdominal pain if the embolism affects the lung bases.
• Aortic Dissection: A life-threatening condition that can cause severe, tearing pain that may be referred to the upper abdomen. It's crucial to consider this diagnosis, especially in hypertensive patients.
• Mesenteric Ischemia: This condition involves insufficient blood flow to the intestines and can cause severe abdominal pain out of proportion to the physical examination, nausea, and vomiting.

Rare Diagnoses

• Pancreatic Cancer: Although less common, pancreatic cancer should be considered in the differential diagnosis, especially if the patient has unexplained weight loss, jaundice, or a history of smoking.
• Hepatic Artery Aneurysm: A rare condition that can cause upper abdominal pain and potentially life-threatening bleeding if ruptured.
• Splenic Artery Aneurysm: Similar to hepatic artery aneurysm, this is a rare condition that can cause upper abdominal pain and is at risk of rupture, especially in pregnant women or those with portal hypertension, though it can occur in anyone.