Differential Diagnosis for Patient Symptoms

The patient's symptoms of pain in the back moving to the front, nausea, and a sensation of passing out can be indicative of several conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Pancreatitis: This condition often presents with severe abdominal pain that radiates to the back, nausea, and vomiting. The pain can be so severe that it causes a sensation of passing out due to pain intensity or associated hypotension.

• Other Likely Diagnoses

  • Gallbladder Disease (Cholecystitis or Cholelithiasis): Symptoms can include severe abdominal pain, often starting in the right upper quadrant and radiating to the back, accompanied by nausea and vomiting.
  • Peptic Ulcer Disease: While the pain typically remains in the abdomen, severe cases can cause systemic symptoms including nausea and a feeling of faintness due to pain or bleeding.
  • Kidney Stones (Nephrolithiasis): Pain from kidney stones can start in the flank and radiate to the abdomen, accompanied by nausea and vomiting. Severe pain can lead to a sensation of passing out.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although classically presenting with chest pain, MI can sometimes present atypically, especially in women, with pain in the back or abdomen, nausea, and a feeling of impending doom that might be mistaken for a sensation of passing out.
  • Aortic Dissection: This is a life-threatening condition where the inner layer of the aorta tears. It can cause severe, tearing chest or back pain that can radiate to the abdomen, accompanied by symptoms like nausea and syncope due to severe pain or hypotension.
  • Pulmonary Embolism (PE): While typically presenting with respiratory symptoms, a large PE can cause sudden onset of chest pain, nausea, and a feeling of impending doom or passing out due to hypoxia or hemodynamic instability.

• Rare Diagnoses

  • Porphyria: A group of disorders that can cause severe abdominal pain, nausea, and neurological symptoms including a sensation of passing out due to autonomic dysfunction.
  • Hereditary Angioedema: A rare genetic disorder that can cause episodes of severe abdominal pain due to edema of the gastrointestinal tract, accompanied by nausea and potentially life-threatening airway edema.

Each of these diagnoses requires careful consideration based on the patient's full clinical presentation, including history, physical examination, and diagnostic tests. The key to narrowing down the differential diagnosis is to consider the pattern of pain, associated symptoms, and any risk factors or underlying conditions the patient may have.