Differential Diagnosis for Abdominal Pain in a 65-year-old Female with Cholecystolithiasis and Polyp

• Single most likely diagnosis:
  • Chronic cholecystitis: This is the most likely diagnosis given the patient's history of cholecystolithiasis and polyp, and the absence of fever and jaundice. The elevated WBC count from last month could indicate a chronic inflammatory process.
• Other Likely diagnoses:
  • Biliary colic: This condition is characterized by intermittent abdominal pain due to gallstones, which the patient has. The absence of fever and jaundice makes this a plausible diagnosis.
  • Choledocholithiasis: Although the patient does not have jaundice, it's possible that a stone could be intermittently obstructing the common bile duct, causing abdominal pain.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Acute cholecystitis: Despite the lack of fever and jaundice, acute cholecystitis is a serious condition that requires prompt attention. The elevated WBC count from last month could be a sign of a recent or ongoing acute inflammatory process.
  • Gallbladder cancer: Although rare, gallbladder cancer can present with abdominal pain and a history of gallstones. The presence of a polyp increases the suspicion for this diagnosis.
  • Mirizzi syndrome: This is a rare condition where a gallstone becomes impacted in the cystic duct, causing obstruction of the common bile duct. It can present with abdominal pain and elevated liver enzymes.
• Rare diagnoses:
  • Porcelain gallbladder: This is a rare condition where the gallbladder wall becomes calcified, which can cause abdominal pain.
  • Gallbladder hydrops: This condition involves the gallbladder becoming distended with fluid, often due to a stone obstructing the cystic duct. It can cause abdominal pain and is more common in children but can occur in adults.