Differential Diagnosis for 83-year-old with Appendicitis-type Abdominal Pain, Headache, and High BP
- Single most likely diagnosis:
- Aortic Dissection: This condition is highly plausible given the combination of severe abdominal pain (which can be referred pain from the aorta), headache (possibly due to hypertension or involvement of the aortic arch), and significantly elevated blood pressure. The age of the patient also increases the risk for aortic dissection.
- Other Likely diagnoses:
- Appendicitis: Although less common in the elderly, appendicitis can present atypically and should be considered, especially with abdominal pain.
- Renal Colic: Severe pain and high blood pressure could be associated with renal colic, especially if a stone is causing an obstruction.
- Hypertensive Emergency: The high blood pressure could be causing end-organ damage, presenting with headache and potentially abdominal pain if there's involvement of renal or other abdominal organs.
- Do Not Miss diagnoses:
- Abdominal Aortic Aneurysm (AAA) Rupture: This is a life-threatening condition that could present with abdominal pain and hypotension, but the high blood pressure in this case does not rule it out entirely.
- Mesenteric Ischemia: This condition can cause severe abdominal pain out of proportion to physical findings and can be associated with hypertension.
- Eclampsia (less likely in this age group but theoretically possible in rare cases of late-onset pregnancy): Though extremely rare in an 83-year-old, any new-onset hypertension with seizures (which could be mistaken for headache) in a pregnant woman is eclampsia until proven otherwise.
- Rare diagnoses:
- Porphyria: A group of disorders that can cause severe abdominal pain, neurological symptoms, and psychiatric disturbances. It's rare but could explain some of the symptoms.
- Lead Poisoning: Can cause abdominal pain and hypertension, though it would be unusual for this to be the primary presentation in an elderly patient without a known exposure history.