Differential Diagnosis for a 23-year-old Female with Left Sided Upper Abdominal Pain Radiating to Bilateral Lower Back and ALT of 48

• Single Most Likely Diagnosis
  • Cholecystitis or Biliary Colic: Although the pain is on the left side, which is less typical for gallbladder disease, the elevated ALT (alanine transaminase) suggests liver or biliary tract involvement. The pain radiating to the lower back could be referred pain.
• Other Likely Diagnoses
  • Pancreatitis: The upper abdominal pain radiating to the back is a classic presentation for pancreatitis. The elevated ALT could be due to the proximity of the pancreas to the liver and shared blood supply, leading to liver enzyme elevation in the context of pancreatic inflammation.
  • Peptic Ulcer Disease (PUD): Although PUD typically presents with epigastric pain, it can sometimes radiate to the back. The elevated ALT might not directly correlate with PUD but could be a coincidental finding or related to another process.
  • Hepatitis: Viral or other forms of hepatitis could explain the elevated ALT. However, the radiating back pain is less typical for hepatitis, which usually presents with more generalized abdominal discomfort or right upper quadrant pain.
• Do Not Miss Diagnoses
  • Ectopic Pregnancy: Although less likely given the presence of abdominal pain and elevated liver enzymes, an ectopic pregnancy can present with abdominal pain and must be considered in any female of childbearing age with abdominal pain, especially if there's a possibility of pregnancy.
  • Pulmonary Embolism: While the presentation is atypical, pulmonary embolism can cause sudden onset of back pain and, in rare cases, abdominal pain if the embolism affects the lung bases. It's a diagnosis that could be deadly if missed.
  • Aortic Dissection: This is a life-threatening condition that can present with severe back pain and, occasionally, abdominal pain if the dissection involves the abdominal aorta. It's crucial to consider this diagnosis, especially if there are risk factors such as hypertension or aortic valve disease.
• Rare Diagnoses
  • Porphyria: A group of disorders that can cause severe abdominal pain, neurological symptoms, and psychiatric disturbances. The pain can be diffuse or localized and may radiate to the back.
  • Diabetic Ketoacidosis (DKA): While DKA typically presents with hyperglycemia, ketosis, and metabolic acidosis, abdominal pain is a common symptom. The back pain could be related to the metabolic disturbances or dehydration.
  • Sickle Cell Crisis: Patients with sickle cell disease can experience episodes of severe pain due to vaso-occlusive crises, which can affect any part of the body, including the abdomen and back.