Differential Diagnosis for Abdominal and Ear Pain

The patient presents with chronic abdominal pain and acute ear pain. Here's a differential diagnosis, categorized for clarity:

• Single Most Likely Diagnosis
  • Irritable Bowel Syndrome (IBS) with referred ear pain: The chronic nature of the abdominal pain, coupled with the acute onset of ear pain, could suggest IBS with referred pain to the ear, possibly due to the common innervation of abdominal and ear regions.
• Other Likely Diagnoses
  • Gastroesophageal Reflux Disease (GERD) with ear pain: Chronic abdominal pain could be due to GERD, and the ear pain might be referred from the esophagus.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis could cause chronic abdominal pain, and while less common, could have extraintestinal manifestations including ear symptoms.
  • Peptic Ulcer Disease: Chronic abdominal pain could be due to a peptic ulcer, and the ear pain might be unrelated or referred.
• Do Not Miss Diagnoses
  • Appendicitis: Although the abdominal pain is chronic, appendicitis can present atypically, especially in older adults, and is a surgical emergency.
  • Ovarian Torsion or Rupture: In female patients, these are emergencies that can cause severe abdominal pain and potentially radiate or refer pain to other areas.
  • Cholecystitis: Inflammation of the gallbladder can cause chronic or acute abdominal pain and is a serious condition requiring prompt treatment.
  • Perforated Viscus: Any condition leading to a perforation in the abdominal cavity is a surgical emergency.
• Rare Diagnoses
  • Abdominal Migraine: A condition that can cause recurrent episodes of severe abdominal pain, often accompanied by other symptoms like headache or ear pain.
  • Porphyrias: A group of rare disorders that can cause acute, severe abdominal pain, and neurological symptoms, including pain in other areas like the ears.
  • Vasculitis: Certain types of vasculitis, like polyarteritis nodosa, can cause a wide range of symptoms including abdominal and ear pain due to inflammation of blood vessels.

Each diagnosis is considered based on the combination of chronic abdominal pain and the acute onset of ear pain, with an emphasis on not missing potentially life-threatening conditions. The justification for each includes the nature of the pain (chronic vs. acute), potential for referred pain, and the presence of any red flag symptoms that would necessitate immediate medical attention.