Differential Diagnosis for Abdominal Pain

The patient presents with abdominal pain that worsens with eating, fever, chills, and a recent history of cough and sore throat. The pain initially starts in the middle of the stomach and then moves to the right side. Given these symptoms, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Acute Cholecystitis: This condition is characterized by inflammation of the gallbladder, often due to gallstones. The patient's symptoms of abdominal pain that worsens with eating (especially fatty foods), fever, and chills, along with the tenderness in the right upper quadrant (as indicated by the patient holding his breath during deep palpation), are classic for acute cholecystitis. The elevated white blood cell count further supports an infectious or inflammatory process.

• Other Likely Diagnoses

  • Peptic Ulcer Disease: The patient's abdominal pain that worsens with eating could suggest peptic ulcer disease. However, the pain typically associated with peptic ulcers is more constant and can be relieved by eating or taking antacids, which doesn't perfectly match this patient's presentation.
  • Hepatitis: Although less likely given the specific pattern of pain, hepatitis could cause right upper quadrant pain and fever. The recent history of cough and sore throat might suggest a viral etiology, but the lack of jaundice or specific liver function test results makes this less clear.
  • Pyelonephritis: This condition involves infection of the kidney and could present with flank pain, fever, and chills. However, the pain typically is more flank-oriented rather than starting centrally and moving to the right upper quadrant.

• Do Not Miss Diagnoses

  • Appendicitis: Although the pain pattern is not typical (appendicitis usually starts around the navel and then moves to the lower right abdomen), appendicitis can present atypically, especially in adults. Missing this diagnosis could lead to perforation and severe consequences.
  • Perforated Visculature or Perforated Ulcer: A perforation in the gastrointestinal tract can lead to peritonitis, which is a life-threatening condition. The patient's abdominal tenderness and guarding (holding his breath during palpation) could suggest peritonitis, but the lack of abdominal distention and severe rebound tenderness makes this less likely.
  • Mesenteric Lymphadenitis: This condition involves inflammation of the lymph nodes in the mesentery and can mimic appendicitis or other causes of abdominal pain. It's often associated with viral infections and could be considered given the patient's recent cough and sore throat.

• Rare Diagnoses

  • Hepatic Abscess: A collection of pus in the liver could cause right upper quadrant pain, fever, and chills. This is less common and would typically be associated with specific risk factors such as biliary disease or immunocompromised states.
  • Pancreatitis: Although pancreatitis can cause severe abdominal pain, it usually presents with more severe symptoms and is associated with elevated pancreatic enzymes, which are not mentioned in the scenario provided.