Differential Diagnosis for Mid-Upper Abdominal Pain

The symptom of pain that feels like it tickles but is tender in the middle of the upper abdomen can be caused by various conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Peptic Ulcer Disease: This condition is characterized by ulcers in the stomach or duodenum, often causing epigastric pain that can be described as burning or tender. The "tickling" sensation might be an atypical description of the discomfort associated with ulcer disease.

• Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): GERD can cause epigastric discomfort or pain due to the reflux of stomach acid into the esophagus. The sensation might be perceived as tickling due to the irritation of the esophagus.
  • Functional Dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause. Patients might describe their discomfort in various ways, including a tickling sensation.
  • Gastritis: Inflammation of the stomach lining can cause upper abdominal pain and tenderness, potentially described as feeling like it tickles due to the unusual nature of the discomfort.

• Do Not Miss Diagnoses

  • Myocardial Infarction: Although less common, myocardial infarction (heart attack) can present with atypical symptoms, including epigastric discomfort. It's crucial to consider this diagnosis, especially in patients with risk factors.
  • Pancreatitis: Inflammation of the pancreas can cause severe upper abdominal pain, which might be described in various ways, including a sensation of tickling due to the radiating nature of the pain.
  • Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant pain but can sometimes be perceived more centrally, especially if the gallbladder is inflamed and irritating adjacent structures.

• Rare Diagnoses

  • Diabetic Gastroparesis: This condition involves delayed stomach emptying due to diabetes, leading to various gastrointestinal symptoms, including unusual sensations of discomfort.
  • Abdominal Migraine: A condition that causes recurrent episodes of severe abdominal pain, often accompanied by other symptoms like nausea and vomiting. The pain can be perceived as a tickling sensation due to its unique nature.
  • Intestinal Obstruction: Although typically presenting with more severe symptoms like vomiting and constipation, early stages of intestinal obstruction might cause atypical abdominal sensations, including a feeling of tickling due to the partial obstruction of the intestines.