Differential Diagnosis for Progressing Generalized Abdominal Pain

Given the patient's symptoms of progressing generalized abdominal pain, abdominal distention, feeling sick, feeling cold, and a background of alcoholic use, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Alcoholic Pancreatitis: This is a likely diagnosis given the patient's history of alcohol use and the symptoms of abdominal pain and distention. Alcoholic pancreatitis can cause severe abdominal pain, nausea, vomiting, and abdominal distention.
• Other Likely Diagnoses
  • Intestinal Obstruction: The symptoms of abdominal distention and generalized abdominal pain could be indicative of an intestinal obstruction, which may be caused by various factors including adhesions, hernias, or tumors.
  • Gastroenteritis: Although less likely given the duration and progression of symptoms, gastroenteritis could still be a consideration, especially if the patient has been exposed to a gastrointestinal pathogen.
  • Hepatic Encephalopathy or Liver Dysfunction: Given the patient's history of alcohol use, liver dysfunction or hepatic encephalopathy could be contributing to the patient's symptoms, including feeling sick and cold.
• Do Not Miss Diagnoses
  • Appendicitis: Although the pain is generalized, appendicitis can sometimes present atypically, especially in older adults or those with a history of alcohol use. Missing this diagnosis could lead to severe consequences, including perforation and peritonitis.
  • Perforated Viscus: A perforation in the gastrointestinal tract can lead to peritonitis, which is a life-threatening condition. The symptoms of severe abdominal pain and distention could be indicative of this condition.
  • Mesenteric Ischemia: This is a condition where there is a lack of blood flow to the intestines, which can be caused by embolism, thrombosis, or venous thrombosis. It is a medical emergency that requires prompt diagnosis and treatment.
• Rare Diagnoses
  • Abdominal Aortic Aneurysm: Although rare, an abdominal aortic aneurysm could present with abdominal pain and distention, especially if it is leaking or has ruptured.
  • Intra-Abdominal Malignancy: Various cancers within the abdomen could cause the patient's symptoms, including ovarian cancer, colon cancer, or stomach cancer, among others.

Management Plan

1. Immediate Assessment: Evaluate the patient's vital signs, perform a thorough physical examination, and obtain a detailed history.
2. Laboratory Tests: Order complete blood count (CBC), blood urea nitrogen (BUN), creatinine, liver function tests (LFTs), amylase, and lipase to help narrow down the differential diagnosis.
3. Imaging Studies: Consider abdominal X-rays, ultrasound, or CT scan to evaluate for intestinal obstruction, pancreatitis, liver disease, or other intra-abdominal pathologies.
4. Supportive Care: Provide fluid resuscitation, pain management, and anti-emetics as needed.
5. Specific Treatment: Based on the diagnosis, initiate specific treatment. For example, if alcoholic pancreatitis is confirmed, manage with bowel rest, pain control, and nutritional support. If an intestinal obstruction is diagnosed, consider surgical intervention.
6. Monitoring: Closely monitor the patient's condition for any signs of deterioration or improvement, adjusting the management plan as necessary.