Differential Diagnosis for 44-year-old Male with Abdominal Pain
Single Most Likely Diagnosis
- Musculoskeletal pain: Given the duration of two weeks and the fact that it wakes him up at night, musculoskeletal pain is a strong consideration. This type of pain can be exacerbated by movement or pressure and can occur at night, disrupting sleep.
Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): Although the patient has normal bowel movements, GERD can cause abdominal pain that worsens at night, especially if the patient lies down after eating.
- Peptic ulcer disease: The pain from a peptic ulcer can be constant and may worsen at night, though it typically improves with eating or antacids.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain, though they are often associated with changes in bowel movements, which this patient does not have.
Do Not Miss Diagnoses
- Appendicitis: Although the patient's symptoms do not perfectly align with classic appendicitis (e.g., no fever, normal bowel movements), atypical presentations can occur, especially in adults. Missing appendicitis can lead to severe consequences, including perforation.
- Pancreatitis: Acute pancreatitis can cause severe abdominal pain that may radiate to the back and can occur at night. It's a condition that requires immediate medical attention.
- Diverticulitis: Inflammation of a diverticulum in the colon can cause severe pain, usually on the lower left side, and can be a medical emergency if complications arise.
Rare Diagnoses
- Intestinal obstruction: This is a condition where the intestine is partially or completely blocked, which can cause severe abdominal pain, though it's often accompanied by vomiting, constipation, or obstipation, which this patient does not exhibit.
- Abdominal aortic aneurysm: A ruptured or leaking abdominal aortic aneurysm can cause severe, sudden-onset abdominal pain, which is a medical emergency. However, this condition is less common in a 44-year-old without significant risk factors.
- Cancer: Various abdominal cancers (e.g., stomach, pancreatic, colon) can cause chronic abdominal pain. While these are less likely given the patient's age and lack of other symptoms, they cannot be entirely ruled out without further investigation.