Differential Diagnosis for Patient with Abdominal Pain and Pancreatic Abnormality

Single Most Likely Diagnosis

• Acute Pancreatitis: This is the most likely diagnosis given the abdominal pain, elevated leukocytes, and the finding on the contrast CT scan indicating an issue with the pancreas. The vomiting and diarrhea could be secondary to the pancreatitis.

Other Likely Diagnoses

• Pyelonephritis or Urinary Tract Infection (UTI): The cloudy urine and elevated leukocytes could suggest a urinary tract infection, which might be contributing to the abdominal pain. However, the primary issue seems to be related to the pancreas.
• Gastroenteritis: Although the vomiting and diarrhea could suggest gastroenteritis, the key finding of an abnormality on the pancreas and the elevated leukocytes point more towards an inflammatory process like pancreatitis.
• Diverticulitis: This condition could cause abdominal pain and elevated leukocytes, but it typically presents with more localized pain (usually lower left quadrant) and the CT findings would more likely show diverticula in the colon.

Do Not Miss Diagnoses

• Perforated Viscus: Although less likely given the description, a perforated viscus (such as a perforated ulcer or perforated intestine) is a surgical emergency that could present with abdominal pain, vomiting, and elevated leukocytes. The CT scan would typically show free air under the diaphragm.
• Appendicitis: Another surgical emergency that could present with abdominal pain, vomiting, and elevated leukocytes. The pain often starts around the navel and then moves to the lower right abdomen.
• Ectopic Pregnancy: In female patients, an ectopic pregnancy could present with abdominal pain and vomiting. Although the CT scan findings would not typically show an issue with the pancreas, it's crucial to consider this diagnosis due to its potential severity.

Rare Diagnoses

• Pancreatic Cancer: While the CT scan shows an abnormality of the pancreas, pancreatic cancer would be less likely to present acutely with such a wide range of symptoms like vomiting and diarrhea unless there was significant obstruction or metastasis.
• Pancreatic Pseudocyst: This could be a complication of pancreatitis but would be less likely as an initial presentation without a history of pancreatitis.
• Intra-abdominal Abscess: Could be a complication of several conditions, including diverticulitis or a perforated viscus, but would typically present with more localized pain and possibly a palpable mass.