What is the differential diagnosis for a 62-year-old female with a history of psoriasis and hypertension, taking lisinopril (angiotensin-converting enzyme inhibitor) and hydrochlorothiazide (thiazide diuretic) combination and dexamethasone (corticosteroid), who is a smoker and consumes alcohol, presenting with pain onset after eating seafood?

Differential Diagnosis for 62-year-old Female with Acute Pain

Single Most Likely Diagnosis

• Acute Pancreatitis: The patient's symptoms started after eating seafood, which could be a trigger for pancreatitis, especially if the seafood was high in fat. The patient's history of alcohol consumption also increases the risk of pancreatitis.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): The patient's symptoms could be related to GERD, especially if the seafood triggered an episode of acid reflux. The patient's history of smoking and alcohol consumption could also contribute to GERD.
• Peptic Ulcer Disease: The patient's use of dexamethasone, a corticosteroid, increases the risk of peptic ulcer disease. The patient's symptoms could be related to a peptic ulcer, especially if the seafood triggered an episode of bleeding or perforation.
• Cholecystitis: The patient's symptoms could be related to cholecystitis, especially if the seafood triggered an episode of gallbladder inflammation.

Do Not Miss Diagnoses

• Myocardial Infarction: Although the patient's symptoms started after eating seafood, it is essential to consider myocardial infarction as a possible diagnosis, especially given the patient's history of hypertension and smoking.
• Pulmonary Embolism: The patient's history of smoking and alcohol consumption increases the risk of pulmonary embolism. It is essential to consider this diagnosis, especially if the patient has any respiratory symptoms.
• Aortic Dissection: The patient's history of hypertension increases the risk of aortic dissection. It is essential to consider this diagnosis, especially if the patient has any symptoms of severe chest or back pain.

Rare Diagnoses

• Eosinophilic Gastroenteritis: The patient's history of psoriasis and use of dexamethasone could increase the risk of eosinophilic gastroenteritis, a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract.
• Food Allergy or Intolerance: The patient's symptoms started after eating seafood, which could suggest a food allergy or intolerance. However, this diagnosis is less likely given the patient's age and lack of previous symptoms.