Differential Diagnosis for Upper Abdominal Pain with Elevated Serum/Plasma Amylase and Lipase

• Single Most Likely Diagnosis

  • Acute Pancreatitis: The patient's symptoms of intense upper abdominal pain radiating to the back, weakness, loss of appetite, and severe indigestion after eating, combined with elevated serum/plasma amylase and lipase, are highly suggestive of acute pancreatitis. These enzymes are commonly elevated in this condition, making it the most likely diagnosis.

• Other Likely Diagnoses

  • Gallbladder Disease: Gallstones can cause obstruction of the pancreatic duct, leading to pancreatitis. However, gallbladder disease itself might present with similar symptoms, including abdominal pain, especially after eating fatty foods. While the enzyme elevations are more specific to pancreatitis, gallbladder disease is a common cause of pancreatitis and should be considered.
  • Acid Reflux Disease: Although less likely given the enzyme elevations, severe acid reflux can cause significant upper abdominal pain and discomfort after eating. However, it would not typically cause elevations in amylase and lipase.

• Do Not Miss Diagnoses

  • Peptic Ulcer Disease: A perforated peptic ulcer can present with severe abdominal pain and could potentially lead to elevated pancreatic enzymes due to the proximity of the ulcer to the pancreas and the potential for chemical peritonitis. Missing this diagnosis could be catastrophic.
  • Cholecystitis: Inflammation of the gallbladder can cause severe abdominal pain and might be associated with pancreatitis if a gallstone is obstructing the common bile duct. It's crucial not to miss this diagnosis due to the risk of complications like gangrene or perforation.

• Rare Diagnoses

  • Pancreatic Cancer: Although rare in a 36-year-old, pancreatic cancer can cause abdominal pain, weight loss, and elevated pancreatic enzymes. It's less likely given the acute presentation but should be considered in the differential, especially if initial treatments for pancreatitis do not lead to improvement.
  • Hypertriglyceridemia-induced Pancreatitis: Extremely high levels of triglycerides can cause pancreatitis. This condition is less common but should be considered, especially if the patient has a history of hyperlipidemia or other risk factors.