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Differential Diagnosis for Acute Epigastric Pain in Patients with Multiple Myeloma

Single Most Likely Diagnosis

  • Hypercalcemia-induced pancreatitis: This condition is a common complication in patients with multiple myeloma due to elevated calcium levels, which can cause pancreatic inflammation, leading to acute epigastric pain.

Other Likely Diagnoses

  • Gastroesophageal reflux disease (GERD): Patients with multiple myeloma may experience GERD due to various factors, including medication side effects, leading to epigastric pain.
  • Peptic ulcer disease: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in multiple myeloma treatment can increase the risk of peptic ulcers, causing acute epigastric pain.
  • Amyloidosis: Amyloid deposits can accumulate in the gastrointestinal tract, including the stomach, leading to epigastric pain in patients with multiple myeloma.

Do Not Miss Diagnoses

  • Myocardial infarction: Although less common, myocardial infarction can present with epigastric pain, especially in patients with atypical symptoms, and is crucial to diagnose promptly due to its high mortality rate.
  • Aortic dissection: This is a life-threatening condition that can cause severe epigastric pain and must be ruled out, especially in patients with hypertension or other risk factors.

Rare Diagnoses

  • Intra-abdominal plasma cell tumors: Rarely, multiple myeloma can manifest as intra-abdominal plasma cell tumors, which can cause epigastric pain due to local compression or infiltration of surrounding tissues.
  • Splenomegaly or splenic infarction: Although less common, splenomegaly or splenic infarction can occur in patients with multiple myeloma, leading to referred epigastric pain.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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