Differential Diagnoses for Acute Pancreatitis

When considering the differential diagnoses for acute pancreatitis, it's crucial to categorize them based on their likelihood and potential impact on patient outcomes. The following list organizes potential diagnoses into Single Most Likely Diagnosis, Other Likely Diagnoses, Do Not Miss Diagnoses, and Rare Diagnoses.

• Single Most Likely Diagnosis

  • Acute cholecystitis: This condition is often confused with acute pancreatitis due to overlapping symptoms such as abdominal pain. However, the pain in cholecystitis is typically more localized to the right upper quadrant.

• Other Likely Diagnoses

  • Peptic ulcer disease: Gastric or duodenal ulcers can cause severe abdominal pain similar to pancreatitis and may require urgent intervention.
  • Intestinal obstruction: Symptoms can mimic those of acute pancreatitis, including severe abdominal pain and vomiting.
  • Mesenteric ischemia: This condition involves insufficient blood flow to the intestines and can present with abdominal pain out of proportion to physical examination findings.
  • Perforated viscus: A hole in the wall of the stomach or intestine can lead to severe abdominal pain and peritonitis, similar to the presentation of acute pancreatitis.

• Do Not Miss Diagnoses

  • Ectopic pregnancy: Although less common in this context, an ectopic pregnancy can present with acute abdominal pain and must be considered, especially in women of childbearing age.
  • Aortic dissection: This is a life-threatening condition that can present with sudden, severe abdominal or back pain and must be promptly diagnosed and treated.
  • Ovarian torsion: This condition involves the twisting of an ovary and can cause severe, acute abdominal pain, often requiring emergency surgery.

• Rare Diagnoses

  • Splenic infarction: Although rare, it can cause acute abdominal pain and may be considered in patients with specific risk factors, such as sickle cell disease or thrombophilic conditions.
  • Diabetic ketoacidosis: While not directly causing abdominal pain through pancreatic inflammation, it can present with severe abdominal pain and vomiting, mimicking acute pancreatitis in diabetic patients.
  • Porphyria: A group of disorders that can result in acute, severe abdominal pain without clear evidence of an inflammatory process like pancreatitis.