Differential Diagnosis for Severe Epigastric Pain
Single Most Likely Diagnosis
- Acute Pancreatitis: This condition is often characterized by severe, persistent epigastric pain that may radiate to the back, accompanied by nausea, vomiting, and abdominal tenderness. The pain typically starts abruptly and can be exacerbated by eating, especially fatty foods.
Other Likely Diagnoses
- Peptic Ulcer Disease: Both gastric and duodenal ulcers can cause severe epigastric pain, which may be described as burning or gnawing. The pain can be relieved by eating or worsened by it, depending on the ulcer's location.
- Gastroesophageal Reflux Disease (GERD): While GERD typically causes heartburn and regurgitation, severe cases can lead to epigastric pain due to esophageal inflammation or spasm.
- Cholecystitis: Inflammation of the gallbladder, often due to gallstones, can cause severe right upper quadrant or epigastric pain, especially after eating fatty foods.
Do Not Miss Diagnoses
- Myocardial Infarction: Although the classic symptom of a heart attack is chest pain, some patients, especially women and diabetics, may present with epigastric pain or discomfort. Missing this diagnosis can be fatal.
- Aortic Dissection: Severe, tearing chest or back pain can sometimes be perceived as epigastric pain. This condition requires immediate medical attention.
- Pulmonary Embolism: While typically presenting with respiratory symptoms, a pulmonary embolism can cause sudden, severe chest or epigastric pain, especially if the embolism is large or involves the lung periphery.
Rare Diagnoses
- Pancreatic Cancer: Although less common, pancreatic cancer can present with epigastric pain, weight loss, and jaundice. It's crucial to consider this diagnosis, especially in older patients or those with a family history.
- Splenic Infarction or Rupture: These conditions can cause severe left upper quadrant or epigastric pain and are more common in patients with spleen enlargement due to various diseases.
- Mesenteric Ischemia: This condition, resulting from decreased blood flow to the intestines, can cause severe, diffuse abdominal pain, including epigastric pain, and is often seen in older patients or those with cardiovascular disease.