What is the cause of constant moderate (6/10) pain in the supra-umbilical abdomen of a 35-year-old breastfeeding mother (postpartum 1.25 years), persisting for 2 days, unrelieved by bowel movements, with a normal examination today?

Differential Diagnosis for Constant Abdominal Pain in a Breastfeeding Mother

• Single most likely diagnosis
  • Musculoskeletal pain (e.g., postpartum muscle strain, poor posture from breastfeeding):
    • This diagnosis is likely due to the fact that the patient is a breastfeeding mother, and such activities can lead to muscle strain. The pain is constant and not relieved by bowel movements, which suggests a non-visceral cause.
• Other Likely diagnoses
  • Constipation:
    • Although the patient mentions that the pain is unrelieved by bowel movements, constipation can sometimes cause abdominal pain that is not entirely relieved by bowel movements.
  • Gastroesophageal reflux disease (GERD):
    • GERD can cause abdominal pain, especially in the supra-umbilical region, and can be exacerbated by breastfeeding or changes in diet.
  • Peptic ulcer disease:
    • Peptic ulcers can cause constant abdominal pain, and the patient's age and breastfeeding status are not strongly protective against this diagnosis.
• Do Not Miss
  • Appendicitis:
    • Although the patient's pain is not typical for appendicitis (supra-umbilical rather than right lower quadrant), appendicitis can present atypically, especially in pregnant or postpartum women.
  • Cholecystitis or biliary colic:
    • These conditions can cause severe abdominal pain, and the patient's age and breastfeeding status are not strongly protective against these diagnoses.
  • Pancreatitis:
    • Pancreatitis can cause severe abdominal pain, and the patient's age and breastfeeding status are not strongly protective against this diagnosis.
• Rare diagnoses
  • Intestinal obstruction:
    • This diagnosis is less likely given the patient's lack of nausea, vomiting, or abdominal distension, but it is still possible, especially if the obstruction is partial.
  • Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis):
    • These conditions can cause chronic abdominal pain, but they are less likely given the patient's age and lack of other symptoms (e.g., diarrhea, weight loss).
  • Abdominal wall hernia:
    • This diagnosis is possible, especially if the patient has had previous abdominal surgery or has a history of hernias, but it is less likely given the patient's lack of a palpable mass or tenderness.