Differential Diagnosis
- Single most likely diagnosis
- Gallstone pancreatitis (E): The patient's symptoms of nausea, vomiting, and abdominal pain radiating to the back, along with elevated amylase and lipase levels, are indicative of pancreatitis. The patient's history of intermittent episodes of cramping abdominal pain after meals and the presence of moderate epigastric and right upper quadrant tenderness suggest a possible gallstone etiology, as gallstones can cause intermittent obstruction of the pancreatic duct, leading to pancreatitis.
- Other Likely diagnoses
- Triglyceride-induced pancreatitis (I): The patient's elevated triglyceride level (300 mg/dL) is a known risk factor for pancreatitis, and the clinical presentation is consistent with this diagnosis.
- Acute cholecystitis (A): The patient's right upper quadrant tenderness and elevated alkaline phosphatase level could suggest acute cholecystitis, although the absence of guarding or rebound tenderness and the presence of elevated pancreatic enzymes make this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pancreatic cancer (F): Although less likely given the patient's age and presentation, pancreatic cancer can cause obstructive jaundice and pancreatitis, and is a diagnosis that should not be missed due to its high mortality rate.
- Ascending cholangitis (D): This diagnosis is less likely given the absence of jaundice and the patient's stable temperature, but it is a potentially life-threatening condition that requires prompt recognition and treatment.
- Rare diagnoses
- Alcoholic pancreatitis (C): The patient's consumption of one to two glasses of wine per evening is unlikely to be sufficient to cause alcoholic pancreatitis, making this diagnosis less likely.
- Alcoholic hepatitis (B): The patient's liver function tests do not suggest significant liver injury, and the patient's alcohol consumption is not sufficient to support a diagnosis of alcoholic hepatitis.
- Hepatitis A (F): The patient's presentation and laboratory results do not suggest hepatitis A, which typically causes more significant elevations in liver enzymes and bilirubin.
- Peptic ulcer disease (H): The patient's symptoms and laboratory results do not suggest peptic ulcer disease, which typically causes more localized abdominal pain and may be associated with gastrointestinal bleeding.