Differential Diagnosis for a 65-year-old man with upper abdominal pain, loss of appetite, weight loss, jaundice, and a palpable non-tender gallbladder
- Single most likely diagnosis
- Pancreatic cancer: The patient's presentation of vague upper abdominal pain, loss of appetite, weight loss, jaundice, and a palpable non-tender gallbladder (Courvoisier's sign) is highly suggestive of pancreatic cancer, particularly in the head of the pancreas, which can obstruct the bile duct and cause these symptoms.
- Other Likely diagnoses
- Cholangiocarcinoma: This is a cancer of the bile duct that can also cause obstructive jaundice and a palpable gallbladder. The symptoms and signs can be very similar to those of pancreatic cancer.
- Gallbladder cancer: Although less common, gallbladder cancer can also present with these symptoms, especially if it obstructs the bile duct.
- Ampullary cancer: A tumor at the ampulla of Vater, where the bile and pancreatic ducts empty into the small intestine, can cause similar symptoms by obstructing the bile duct.
- Do Not Miss diagnoses
- Choledocholithiasis (gallstones in the bile duct): While less likely given the palpable non-tender gallbladder, it's crucial not to miss this diagnosis as it can cause obstructive jaundice and may require urgent intervention.
- Pancreatitis: Both acute and chronic pancreatitis can present with abdominal pain and jaundice, although the gallbladder is less likely to be palpable in these conditions.
- Rare diagnoses
- Metastatic cancer to the pancreas or bile ducts: Although rare, cancers from other primary sites can metastasize to the pancreas or bile ducts, causing obstructive jaundice and other symptoms.
- Primary sclerosing cholangitis: A chronic liver disease that leads to scarring, inflammation, and destruction of the bile ducts, which can cause obstructive jaundice and potentially a palpable gallbladder, although it's less common in this presentation.
- Caroli's disease: A rare congenital disorder of the bile ducts that can cause recurrent cholangitis and potentially obstructive jaundice, though it's uncommon to present for the first time in an elderly individual.