Differential Diagnosis for 71F with Epigastric Pain and Nausea

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD) or Peptic Ulcer Disease (PUD): Given the patient's history of nausea, epigastric pain, and questionable H. Pylori, these conditions are highly plausible. The symptoms of nausea when eating or not eating and the feeling of vomiting without actual vomiting are consistent with GERD or PUD, especially in the context of possible H. Pylori infection, which is a known cause of peptic ulcers.

Other Likely Diagnoses

• Functional Dyspepsia: This condition is characterized by chronic or recurrent upper abdominal pain or discomfort that is not explained by other pathologic conditions. Given the patient's symptoms of epigastric pain and nausea without a clear cause, functional dyspepsia is a consideration.
• Gastritis: Inflammation of the stomach lining can cause nausea, vomiting, and epigastric pain. The patient's symptoms and possible H. Pylori infection make gastritis a likely diagnosis.
• Sarcoidosis Involvement of the Gastrointestinal Tract: Although less common, sarcoidosis can involve the gastrointestinal tract and cause symptoms similar to those the patient is experiencing.

Do Not Miss Diagnoses

• Myocardial Infarction: It is crucial to consider cardiac causes of epigastric pain, especially in a patient with a history of heart disease (HLD). Myocardial infarction can present atypically, especially in women and older adults, with symptoms such as epigastric discomfort or nausea.
• Pancreatitis: Acute pancreatitis can cause severe epigastric pain and nausea. Although the patient's symptoms have been present for over a week, which is longer than the typical onset of acute pancreatitis, it's essential to rule out this condition due to its severity.
• Gastric Cancer: Although less likely, gastric cancer can cause epigastric pain, nausea, and vomiting. Given the patient's age and symptoms, it is essential to consider this diagnosis to ensure timely evaluation and treatment if present.

Rare Diagnoses

• Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid production due to a gastrin-secreting tumor, leading to severe peptic ulcers and diarrhea.
• Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause abdominal pain, nausea, and vomiting.

The skin symptoms on the forearm are likely unrelated to the gastrointestinal symptoms and could indeed be due to poison ivy or another contact dermatitis, as suggested by the patient's response to hydrocortisone cream being ineffective. Further evaluation of both the gastrointestinal and skin symptoms is necessary to determine the exact causes and appropriate treatments.