Differential Diagnosis
- Single most likely diagnosis
- Biliary colic or recurrent cholecystitis: The patient's symptoms of right upper abdominal pain radiating to the back, throbbing pain, and the fact that it happens once a fortnight, especially at night, are suggestive of biliary colic. The presence of fatty liver and slightly elevated liver enzymes also supports this diagnosis, as gallstones are more common in patients with fatty liver disease.
- Other Likely diagnoses
- Peptic ulcer disease: The pain radiating to the back of the throat could be indicative of peptic ulcer disease, although the endoscopy was unremarkable. It's possible that the ulcer is located in a difficult-to-reach area or that the symptoms are intermittent.
- Chronic pancreatitis: The patient's symptoms of abdominal pain radiating to the back, elevated CRP and ESR, and slightly elevated liver enzymes could be suggestive of chronic pancreatitis.
- Functional dyspepsia: The patient's symptoms of recurrent abdominal pain, especially at night, could be indicative of functional dyspepsia.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pancreatic cancer: Although the patient's symptoms and test results are not strongly suggestive of pancreatic cancer, it's a diagnosis that should not be missed due to its high mortality rate.
- Cholangiocarcinoma: Similarly, cholangiocarcinoma is a rare but deadly diagnosis that should be considered, especially given the patient's symptoms of abdominal pain and elevated liver enzymes.
- Hepatic artery aneurysm: This is a rare but potentially life-threatening condition that could cause abdominal pain and elevated liver enzymes.
- Rare diagnoses
- Sphincter of Oddi dysfunction: This is a rare condition that could cause recurrent abdominal pain, especially if the patient has a history of sphincterotomy or other biliary procedures.
- Abdominal migraine: This is a rare condition that could cause recurrent abdominal pain, especially in patients with a history of migraines.
- Intermittent intestinal obstruction: This is a rare condition that could cause recurrent abdominal pain, especially if the patient has a history of abdominal surgery or other intestinal disorders.