Differential Diagnosis for Patient with Alcohol Withdrawal and Abdominal Pain
- Single most likely diagnosis:
- Alcoholic pancreatitis: Although the amylase level is normal, it can be elevated in only about 70% of cases of pancreatitis. The patient's history of alcohol withdrawal and epigastric pain, which can radiate to the back, makes this a strong consideration. The normal liver function tests do not rule out pancreatitis.
- Other Likely diagnoses:
- Peptic ulcer disease: Alcohol use is a risk factor for peptic ulcers, and the epigastric pain could be consistent with this diagnosis. The raised CRP could indicate inflammation.
- Cholecystitis: Right upper quadrant pain and raised CRP could suggest cholecystitis, especially if the patient has gallstones, which are more common in individuals with a history of alcohol use.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Perforated viscus: Although less likely, a perforated viscus (such as a perforated ulcer) is a surgical emergency that requires immediate attention. The presence of severe abdominal pain and raised CRP warrants consideration of this diagnosis.
- Hepatic artery thrombosis or other vascular complications: While liver function tests are normal, vascular complications can occur without significant elevations in liver enzymes initially.
- Rare diagnoses:
- Splenic infarction or other splenic complications: These could occur in the context of alcohol withdrawal, especially if there's an underlying condition affecting the spleen.
- Aortic dissection: Although rare, it's a catastrophic condition that can present with severe abdominal or back pain and should be considered, especially if there are other risk factors such as hypertension.