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Differential Diagnosis for Unintentional Weight Loss, Epigastric Firmness, and Tenderness

Single Most Likely Diagnosis

  • Gastric Cancer: This is a leading consideration due to the combination of unintentional weight loss, epigastric firmness, and tenderness, which are common presenting symptoms of gastric cancer. The epigastric location is suggestive of a gastric origin.

Other Likely Diagnoses

  • Peptic Ulcer Disease: Both gastric and duodenal ulcers can cause epigastric pain and tenderness. While they might not always lead to significant weight loss, complications such as perforation or obstruction could contribute to these symptoms.
  • Chronic Pancreatitis: This condition can cause epigastric pain, weight loss due to malabsorption, and tenderness. The pain often radiates to the back and worsens after eating.
  • Gastroesophageal Reflux Disease (GERD): Although less likely to cause significant weight loss, severe GERD can lead to epigastric discomfort and tenderness, especially if there's an associated stricture or Barrett's esophagus.

Do Not Miss Diagnoses

  • Pancreatic Cancer: Despite being less common than other causes of epigastric pain, pancreatic cancer is often deadly if not caught early. It can present with weight loss, epigastric pain, and occasionally jaundice.
  • Gastric Lymphoma: A type of cancer that can mimic many of the symptoms of gastric cancer, including weight loss and epigastric discomfort.
  • Infectious Causes (e.g., Tuberculosis): Abdominal tuberculosis can cause weight loss, abdominal pain, and tenderness, including in the epigastric region. It's crucial to consider in endemic areas or in individuals with risk factors.

Rare Diagnoses

  • Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid production leading to severe peptic ulcer disease, which could cause the described symptoms.
  • Eosinophilic Gastroenteritis: A rare condition involving eosinophilic infiltration of the gastrointestinal tract, which can cause abdominal pain, weight loss, and occasionally epigastric tenderness.
  • Sarcoidosis Involving the Stomach: Although rare, sarcoidosis can involve any part of the gastrointestinal tract, including the stomach, leading to a variety of symptoms including weight loss and abdominal pain.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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