Differential Diagnosis for 50-year-old Male with Right Sided Epigastric Pain
- Single most likely diagnosis:
- Peptic Ulcer Disease (PUD): The patient's symptoms of epigastric pain and burning are classic for PUD, which is a common condition in adults. The location of the pain on the right side could suggest a duodenal ulcer.
- Other Likely diagnoses:
- Gastroesophageal Reflux Disease (GERD): Although the pain is described as epigastric, GERD can cause burning chest and upper abdominal pain, which might be perceived as epigastric.
- Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant or epigastric pain, especially after eating fatty foods.
- Pancreatitis: While the pain is typically more central, pancreatitis can cause epigastric pain radiating to the back.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Myocardial Infarction (MI): Although the EKG is normal, cardiac causes of chest pain should always be considered, especially in a 50-year-old male. MI can present atypically, especially in diabetic patients.
- Aortic Dissection: This is a rare but life-threatening condition that can cause severe, tearing chest pain, which might be referred to the epigastric region.
- Pulmonary Embolism: While less common, a pulmonary embolism can cause chest pain that might be perceived as epigastric, especially if it involves the lower lobes.
- Rare diagnoses:
- Hepatic or renal pathology (e.g., hepatitis, pyelonephritis): These conditions can cause right upper quadrant or flank pain but might be perceived as epigastric.
- Gastric cancer: Although rare, especially in a 50-year-old without significant risk factors, gastric cancer can cause epigastric pain and should be considered in the differential diagnosis, especially if the pain is persistent and accompanied by other symptoms like weight loss or difficulty swallowing.