Differential Diagnosis for Abdominal Pain, Splenomegaly, and Bruising
Single Most Likely Diagnosis
- Idiopathic Thrombocytopenic Purpura (ITP): This condition is characterized by low platelet count, leading to bruising, and can be associated with splenomegaly. Abdominal pain may occur due to splenic enlargement or other unrelated causes.
Other Likely Diagnoses
- Leukemia: Various forms of leukemia (e.g., acute lymphoblastic leukemia, chronic lymphocytic leukemia) can present with splenomegaly, abdominal pain, and bruising due to thrombocytopenia or bone marrow infiltration.
- Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can cause splenomegaly and abdominal pain. Bruising may be seen if there is associated thrombocytopenia or if the lymphoma involves the bone marrow.
- Hypersplenism: This condition, characterized by splenic sequestration of blood cells, can lead to cytopenias (including thrombocytopenia, causing bruising), splenomegaly, and abdominal pain.
Do Not Miss Diagnoses
- Splenetic Rupture: Although less common, a ruptured spleen can present with acute abdominal pain and is a medical emergency. It might not always be associated with significant bruising but can occur in the context of trauma or spontaneous rupture in diseases like leukemia or lymphoma.
- Hemophagocytic Lymphohistiocytosis (HLH): A rare but life-threatening condition characterized by excessive immune activation, leading to phagocytosis of blood cells, including platelets, which can cause bruising. It often presents with fever, splenomegaly, and abdominal pain.
- Sepsis: In cases of severe infection, abdominal pain, splenomegaly (due to septic emboli or reactive splenomegaly), and bruising (from disseminated intravascular coagulation) can occur. Sepsis is a medical emergency.
Rare Diagnoses
- Primary Myelofibrosis: A myeloproliferative neoplasm that can lead to splenomegaly and abdominal pain. Bruising might be seen if there is associated thrombocytopenia or dysfunction.
- Gaucher's Disease: A genetic disorder leading to the accumulation of glucocerebroside in cells, which can cause splenomegaly, abdominal pain, and bruising due to thrombocytopenia.
- Systemic Mastocytosis: A condition characterized by the accumulation of mast cells in various organs, including the spleen, which can lead to splenomegaly, abdominal pain, and bruising due to mast cell mediator release affecting platelet function.