Differential Diagnosis for Stage IV Endometrial Cancer, Hypertension, and CKD Stage III with Left Upper Quadrant Abdominal Pain

Single Most Likely Diagnosis

• Metastatic Disease Involving the Upper GI Tract or Liver: Given the patient's history of stage IV endometrial cancer, it is highly likely that the current symptoms are related to metastatic disease affecting the upper gastrointestinal tract or liver, which could cause left upper quadrant abdominal pain, nausea, vomiting, and diarrhea due to obstruction, liver dysfunction, or direct tumor effects.

Other Likely Diagnoses

• Gastroenteritis: An infection of the stomach and intestines could explain the nausea, vomiting, diarrhea, and abdominal pain. Although less specific to the patient's cancer history, it's a common condition that could complicate the patient's existing health issues.
• Constipation with Obstruction: Especially in patients with cancer, constipation can be a significant issue, potentially leading to obstruction, which could cause the symptoms described.
• Medication Side Effects: Many medications used in the treatment of cancer, hypertension, and CKD can cause gastrointestinal side effects, including nausea, vomiting, and diarrhea.

Do Not Miss Diagnoses

• Bowel Obstruction: A potentially life-threatening condition that requires immediate intervention. Given the patient's history of abdominal cancer, there's a risk of bowel obstruction either from the tumor itself or from adhesions.
• Splenetic Infarction or Rupture: Although less common, given the left upper quadrant pain, it's crucial to consider splenic issues, especially if there's any history of splenomegaly or if the patient has a hypercoagulable state due to cancer.
• Mesenteric Ischemia: This is a medical emergency that could present with severe abdominal pain out of proportion to physical examination findings. The patient's history of hypertension and CKD increases the risk of vascular disease.

Rare Diagnoses

• Neutropenic Enterocolitis: If the patient is currently undergoing or has recently undergone chemotherapy, there's a risk of neutropenic enterocolitis, a potentially life-threatening condition requiring prompt treatment.
• Hepatic Veno-Occlusive Disease: Also known as sinusoidal obstruction syndrome, this is a rare but serious complication of chemotherapy, particularly in patients with pre-existing liver disease or those undergoing high-dose chemotherapy.
• Primary or Metastatic Splenic Tumor: Although rare, given the left upper quadrant pain, it's worth considering, especially in a patient with a known history of cancer.