Differential Diagnosis for 70yo Man with Indigestion, Black Stool, and Abdominal Discomfort
- Single Most Likely Diagnosis
- Peptic Ulcer Disease (PUD): The patient's symptoms of indigestion, black stool (indicative of melena, which is a sign of upper GI bleeding), and abdominal discomfort are classic for PUD. The age of the patient and the absence of other significant medical history also support this diagnosis, as PUD is common in older adults.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): While GERD typically presents with symptoms of heartburn and regurgitation, it can sometimes cause upper GI bleeding leading to black stools, especially if there is an associated ulceration or erosion.
- Gastritis: Gastritis, especially if caused by NSAIDs or alcohol (though the patient is not on any medications, alcohol use is not mentioned), can lead to similar symptoms, including abdominal discomfort and upper GI bleeding.
- Do Not Miss Diagnoses
- Gastric Cancer: Although less likely, gastric cancer can present with nonspecific symptoms such as indigestion, abdominal discomfort, and upper GI bleeding. Given the potential severity of this diagnosis, it is crucial not to miss it, especially in an older adult.
- Esophageal Varices: These are dilated sub-mucosal veins in the lower esophagus, typically seen in patients with liver cirrhosis and portal hypertension. While the patient has no known liver disease, varices can cause significant upper GI bleeding and should be considered, especially if other signs of liver disease are present upon further evaluation.
- Rare Diagnoses
- Dieulafoy's Lesion: A rare cause of upper GI bleeding characterized by a small, usually solitary mucosal defect with an exposed, often large caliber, artery at its base. It can present with sudden, severe bleeding and is more common in older adults.
- Aorto-enteric Fistula: A rare but potentially life-threatening condition where there is a fistulous connection between the aorta and the intestine, often presenting with GI bleeding. This condition is more common in patients with prior aortic surgery or aneurysm but should be considered in the differential of unexplained upper GI bleeding in older adults.