Differential Diagnosis
- Single most likely diagnosis
- Biliary colic or gallbladder dysfunction: The patient's symptoms of right upper abdominal pain radiating to the back, throbbing pain, and slightly elevated liver enzymes are consistent with biliary colic or gallbladder dysfunction. The presence of a fatty liver may also contribute to gallbladder dysfunction. Although the ultrasound and CT abdomen were unremarkable, it's possible that the gallbladder was not visualized during a period of active inflammation or that the stones were not detected.
- Other Likely diagnoses
- Peptic ulcer disease: The patient's symptoms of abdominal pain radiating to the back and the back of the throat could be consistent with peptic ulcer disease, especially given the recent travel to southeast Asia, which may increase the risk of Helicobacter pylori infection. However, the endoscopy was unremarkable, which makes this diagnosis less likely.
- Hepatic steatosis or fatty liver disease: The patient's slightly elevated liver enzymes and fatty liver on imaging could be contributing to their symptoms, although this is more likely to cause chronic rather than acute symptoms.
- Viral gastroenteritis: The patient's recent travel to southeast Asia and symptoms of abdominal pain could be consistent with viral gastroenteritis, although the stool sample was unremarkable.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cholecystitis: Although the ultrasound and CT abdomen were unremarkable, cholecystitis is a serious condition that requires prompt diagnosis and treatment. The patient's symptoms and slightly elevated CRP and ESR make this a possibility that should not be missed.
- Pancreatitis: The patient's symptoms of abdominal pain radiating to the back and elevated liver enzymes could be consistent with pancreatitis, which is a life-threatening condition if not promptly diagnosed and treated.
- Hepatic abscess or infection: The patient's symptoms and slightly elevated liver enzymes could be consistent with a hepatic abscess or infection, which would require prompt antibiotic treatment.
- Rare diagnoses
- Amebic liver abscess: The patient's recent travel to southeast Asia and symptoms of abdominal pain could be consistent with an amebic liver abscess, although this is a rare condition.
- Eosinophilic gastroenteritis: The patient's symptoms of abdominal pain and elevated ESR could be consistent with eosinophilic gastroenteritis, although this is a rare condition.
- Hepatic artery aneurysm or thrombosis: The patient's symptoms of abdominal pain and elevated liver enzymes could be consistent with a hepatic artery aneurysm or thrombosis, although these are rare conditions that would typically require more severe symptoms and abnormal imaging findings.