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. The unremarkable ultrasound and CT abdomen may not have captured the gallbladder pathology, especially if the symptoms are intermittent.
- Other Likely diagnoses
- Peptic ulcer disease: The pain radiating to the back of the throat and the fact that it happens at night could be suggestive of peptic ulcer disease. However, the endoscopy was unremarkable, which makes this diagnosis less likely.
- Chronic pancreatitis: The patient's symptoms of abdominal pain radiating to the back and the elevated CRP and ESR could be suggestive of chronic pancreatitis. However, the CT abdomen was unremarkable, which makes this diagnosis less likely.
- Infectious diseases such as giardiasis or amoebiasis: The patient's travel history to southeast Asia and the fact that the symptoms have been ongoing for 2 years could suggest an infectious etiology. However, the stool sample was unremarkable, which makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hepatic artery aneurysm or other vascular abnormalities: Although the CT abdomen was unremarkable, it is essential to consider vascular abnormalities, which could be life-threatening if missed.
- Malignancy: Although the patient's symptoms and investigations do not strongly suggest malignancy, it is essential to consider this diagnosis, especially given the patient's age and the fact that the symptoms have been ongoing for 2 years.
- 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 interventions.
- Abdominal migraine: This is a rare condition that could cause recurrent abdominal pain, especially if the patient has a history of migraines or other neurological disorders.
- Eosinophilic gastroenteritis: This is a rare condition that could cause recurrent abdominal pain, especially if the patient has a history of allergies or other eosinophilic disorders.