Epigastric Pain Differential Diagnosis
Epigastric pain can be caused by a variety of conditions, ranging from benign to life-threatening. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Peptic Ulcer Disease (PUD): This is often the most common cause of epigastric pain, especially if the pain is related to eating or is relieved by antacids. The justification for this being the single most likely diagnosis is based on its prevalence and the typical presentation of epigastric pain that is either exacerbated or relieved by food intake.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Characterized by symptoms of heartburn and regurgitation, GERD is a common condition that can cause epigastric discomfort.
- Gastritis: Inflammation of the stomach lining can cause epigastric pain and is often associated with nausea, vomiting, and bloating.
- Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant pain that may radiate to the epigastrium, especially after fatty meals.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although the classic presentation of MI is chest pain, some patients, especially women and diabetics, may present with epigastric pain as the primary symptom. Missing this diagnosis can be fatal.
- Pancreatitis: Both acute and chronic pancreatitis can present with severe epigastric pain radiating to the back, and missing this diagnosis can lead to serious complications.
- Aortic Dissection: This is a life-threatening condition where there is a tear in the aorta's inner layer. Epigastric pain can be a presenting symptom, especially if the dissection involves the descending aorta.
- Esophageal Rupture (Boerhaave's Syndrome): A rare but life-threatening condition where the esophagus ruptures, often presenting with severe chest or epigastric pain.
Rare Diagnoses
- Gastric Cancer: Although rare, gastric cancer can present with epigastric pain, weight loss, and other non-specific symptoms.
- Pancreatic Cancer: Similar to gastric cancer, pancreatic cancer can cause epigastric pain, especially if the tumor is located in the head of the pancreas.
- Splenic Infarction: This can cause left upper quadrant pain that may radiate to the epigastrium, especially in patients with sickle cell disease or other conditions that predispose to splenic infarction.
- Diabetic Ketoacidosis (DKA): While not primarily a cause of epigastric pain, DKA can present with abdominal pain, including epigastric pain, in addition to its classic symptoms of hyperglycemia, metabolic acidosis, and ketosis.