Differential Diagnosis for Alcoholic with Abdominal Pain and Loose Greasy Stools

Single Most Likely Diagnosis

• Pancreatitis: This condition is highly likely due to the patient's history of alcoholism, which is a major risk factor for pancreatitis. The symptoms of abdominal pain and loose, greasy stools (steatorrhea) are consistent with this diagnosis, as pancreatitis can lead to malabsorption of fats.

Other Likely Diagnoses

• Alcoholic Liver Disease: Given the patient's alcoholism, liver disease is a plausible diagnosis. While it may not directly cause greasy stools, it can lead to abdominal pain and other gastrointestinal symptoms.
• Gastroenteritis: Alcoholics are more susceptible to infections, including gastroenteritis, which could explain the abdominal pain and loose stools.
• Malabsorption: Chronic alcohol abuse can lead to malabsorption due to damage to the pancreas or small intestine, resulting in symptoms like steatorrhea.

Do Not Miss Diagnoses

• Intestinal Ischemia: Although less common, intestinal ischemia is a serious condition that requires prompt diagnosis. Alcoholics may be at higher risk due to associated cardiovascular disease. Symptoms can include abdominal pain and changes in bowel habits.
• Bowel Obstruction: This is a medical emergency that could present with abdominal pain and alterations in stool. While not directly related to alcoholism, it's crucial not to miss this diagnosis.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain and changes in bowel habits, including loose stools. While not directly linked to alcoholism, IBD can be exacerbated by alcohol use.

Rare Diagnoses

• Whipple's Disease: A rare, systemic bacterial infection that can cause malabsorption, leading to symptoms like steatorrhea, abdominal pain, and weight loss. It's more common in middle-aged men but is very rare.
• Short Bowel Syndrome: This condition, resulting from a significant loss of intestinal tissue, can lead to severe malabsorption. It's rare and usually follows surgical removal of a large portion of the small intestine.
• Amyloidosis: A condition characterized by the deposition of amyloid proteins in various tissues, including the gastrointestinal tract, which can lead to malabsorption and abdominal pain. It's rare and often associated with chronic diseases or familial predisposition.