Differential Diagnosis
The patient's symptoms of decreased appetite, nausea, vomiting, mid epigastric abdominal pain, weight loss, temporal wasting, and jaundice suggest a serious underlying condition. The following differential diagnoses are considered:
Single most likely diagnosis
- Pancreatic cancer: The patient's symptoms, particularly the mid epigastric abdominal pain, weight loss, and jaundice, are highly suggestive of pancreatic cancer. The tumor marker CA 19-9 is often elevated in pancreatic cancer, making it a likely diagnosis.
Other Likely diagnoses
- Cholangiocarcinoma: This is a cancer of the bile duct that can cause jaundice, weight loss, and abdominal pain. While less common than pancreatic cancer, it is still a possible diagnosis.
- Gastric cancer: Stomach cancer can also cause weight loss, nausea, vomiting, and abdominal pain. However, the presence of jaundice is less common in gastric cancer.
- Ampullary cancer: This is a rare cancer of the ampulla of Vater, which can cause jaundice and abdominal pain.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pancreatitis: While acute pancreatitis is usually associated with severe abdominal pain, chronic pancreatitis can cause weight loss, abdominal pain, and jaundice. It is essential to consider this diagnosis to avoid missing a potentially treatable condition.
- Hepatocellular carcinoma: This is a type of liver cancer that can cause weight loss, abdominal pain, and jaundice. Although less likely than pancreatic cancer, it is crucial to consider this diagnosis due to its potential severity.
Rare diagnoses
- Alpha-fetoprotein (AFP)-producing tumors: These are rare tumors that can produce AFP, a tumor marker typically associated with hepatocellular carcinoma or germ cell tumors.
- Beta human chorionic gonadotropin (β-hCG)-producing tumors: These are rare tumors that can produce β-hCG, a tumor marker typically associated with choriocarcinoma or germ cell tumors.
- CA 15-3-producing tumors: This tumor marker is typically associated with breast cancer, which is less likely to cause the patient's symptoms. However, it is essential to consider this diagnosis in the context of metastatic breast cancer.