Differential Diagnosis for Upper Abdominal Pain

The patient presents with upper abdominal pain that worsens throughout the day, radiates to the back, and has attempted bowel movements with minimal relief. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Constipation: The patient's symptoms of upper abdominal pain, worsening throughout the day, and radiating to the back, along with the use of suppositories, Miralax, and stool softener, suggest constipation as a primary cause. The small bowel movement in the morning provides some relief, further supporting this diagnosis.
• Other Likely Diagnoses
  • Gastroesophageal Reflux Disease (GERD): The worsening pain throughout the day could be related to increased acid production and reflux, especially if the patient has a history of GERD or similar symptoms.
  • Peptic Ulcer Disease: Abdominal pain that worsens throughout the day and radiates to the back could be indicative of a peptic ulcer, especially if the patient has a history of NSAID use or Helicobacter pylori infection.
  • Irritable Bowel Syndrome (IBS): Although the patient denies diarrhea, IBS can present with abdominal pain and changes in bowel habits, which could be considered given the patient's symptoms and attempted treatments.
• Do Not Miss Diagnoses
  • Pancreatitis: The radiating back pain is a red flag for pancreatitis, which can be life-threatening if not promptly diagnosed and treated. Although the patient denies vomiting and fever, these symptoms can be absent in some cases.
  • Cholecystitis: Inflammation of the gallbladder can cause severe abdominal pain, especially after eating, and can radiate to the back. This diagnosis is critical to consider due to the potential for serious complications if left untreated.
  • Appendicitis (although less likely given the upper abdominal pain): Appendicitis typically presents with lower abdominal pain, but it can occasionally present with upper abdominal pain, especially if the appendix is located in an atypical position.
• Rare Diagnoses
  • Intestinal Obstruction: Although the patient has had some bowel movements, a partial obstruction could still be present, causing worsening abdominal pain throughout the day.
  • Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis): These conditions can cause chronic abdominal pain, changes in bowel habits, and other systemic symptoms, but they are less likely given the acute presentation and lack of other symptoms such as weight loss or bloody stools.
  • Abdominal Aortic Aneurysm: This is a rare but life-threatening condition that can cause abdominal and back pain, especially in older adults with risk factors such as smoking or hypertension.