Differential Diagnosis

The patient presents with nausea, vomiting, constant upper abdominal pain, jaundice, and abnormal liver enzymes. Based on the provided information, the differential diagnosis can be categorized as follows:

• Single most likely diagnosis
  • Cholestasis due to Choledocholithiasis (gallstones in the common bile duct): The patient's symptoms of upper abdominal pain, jaundice, and elevated alkaline phosphatase and bilirubin levels are consistent with cholestasis. The elevated lipase level also suggests pancreatic involvement, which can occur with choledocholithiasis.
• Other Likely diagnoses
  • Cholecystitis: Inflammation of the gallbladder, which can cause upper abdominal pain, nausea, and vomiting. However, the absence of fever and the presence of jaundice make choledocholithiasis more likely.
  • Pancreatitis: Inflammation of the pancreas, which can cause upper abdominal pain, nausea, and vomiting. The elevated lipase level supports this diagnosis, but the presence of jaundice and elevated alkaline phosphatase suggests a biliary component.
  • Hepatitis: Inflammation of the liver, which can cause jaundice, nausea, and vomiting. However, the patient's symptoms and laboratory results are more consistent with a biliary or pancreatic disorder.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Peptic Ulcer Disease: A perforated peptic ulcer can cause severe abdominal pain and vomiting, and can be life-threatening if not promptly treated. Although the patient's symptoms are not typical for peptic ulcer disease, it is essential to consider this diagnosis due to its potential severity.
  • Biliary obstruction due to a tumor: A tumor obstructing the bile duct can cause jaundice, abdominal pain, and elevated liver enzymes. Although less likely, this diagnosis is critical to consider due to its potential for severe consequences if left untreated.
• Rare diagnoses
  • Primary biliary cirrhosis: A chronic liver disease that can cause cholestasis and elevated alkaline phosphatase levels. However, this diagnosis is less likely given the patient's acute presentation.
  • Primary sclerosing cholangitis: A chronic liver disease that can cause cholestasis and elevated alkaline phosphatase levels. This diagnosis is rare and typically presents with a more gradual onset of symptoms.