Differential Diagnosis for Stomach Pain Radiating to Back

• Single most likely diagnosis
  • Peptic Ulcer Disease: This is often the most common cause of stomach pain that radiates to the back. The pain is typically described as a burning or gnawing sensation in the upper abdomen that may radiate to the mid-back. Justification: The location and nature of the pain, along with potential triggers such as food or anti-inflammatory drug use, align with peptic ulcer disease.
• Other Likely diagnoses
  • Gastroesophageal Reflux Disease (GERD): While GERD typically presents with heartburn, some patients may experience upper abdominal pain radiating to the back due to acid reflux. Justification: Symptoms such as worsening pain with lying down or eating certain foods support this diagnosis.
  • Pancreatitis: Both acute and chronic pancreatitis can cause severe abdominal pain that radiates to the back. Justification: The pain is often constant, severe, and may be accompanied by nausea, vomiting, or changes in bowel movements.
  • Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant abdominal pain that may radiate to the back or right shoulder. Justification: Pain after eating fatty foods, fever, or jaundice may indicate cholecystitis.
• Do Not Miss diagnoses
  • Myocardial Infarction: Although less common, myocardial infarction (heart attack) can present with epigastric discomfort or pain radiating to the back, especially in women or diabetic patients. Justification: The potential for a life-threatening condition necessitates consideration, especially with associated symptoms like shortness of breath, sweating, or chest pain.
  • Aortic Dissection: A tear in the aorta's inner layer can cause sudden, severe pain that may start in the chest and radiate to the back. Justification: This is a medical emergency, and any suspicion based on symptoms like severe, tearing chest or back pain warrants immediate investigation.
  • Esophageal Rupture: A rupture of the esophagus can cause severe chest or abdominal pain radiating to the back, often accompanied by difficulty swallowing or breathing. Justification: The severity and potential for rapid deterioration make this a critical diagnosis not to miss.
• Rare diagnoses
  • Gastric Cancer: Abdominal pain that radiates to the back can be a symptom of gastric cancer, though it's less common. Justification: Unexplained weight loss, difficulty swallowing, or persistent abdominal pain in the context of risk factors like family history or Helicobacter pylori infection might suggest this diagnosis.
  • Splenic Infarction: Pain from the spleen can radiate to the left upper back. Justification: This condition is rare but can occur in the context of sickle cell disease, blood clots, or trauma.
  • Retroperitoneal Fibrosis: A rare condition characterized by the proliferation of fibrous tissue in the retroperitoneum, which can cause back and abdominal pain. Justification: The diagnosis is often considered when other causes of pain have been ruled out and there are associated symptoms like urinary obstruction.