Differential Diagnosis for 20 Weeks Pregnant Woman with Left Flank Pain, Loss of Appetite, Fever, Vomiting, and Abnormal Lab Results
Single Most Likely Diagnosis
- Pyelonephritis: This is the most likely diagnosis given the patient's symptoms of left flank pain, fever, vomiting, and laboratory results showing a high white blood cell count (15,600) and the presence of 10 to 20 WBCs in the urine. Pyelonephritis, an infection of the kidney, is a common cause of such symptoms, especially in pregnant women due to physiological changes that can predispose to urinary tract infections.
Other Likely Diagnoses
- Kidney Stone (Nephrolithiasis): Although the presence of WBCs in the urine and fever might lean more towards an infectious cause, kidney stones can cause severe flank pain and vomiting. The pain can sometimes be accompanied by a low-grade fever if there's an associated infection, but the primary issue is the obstruction caused by the stone.
- Pre-eclampsia: This condition, characterized by high blood pressure and often protein in the urine, can sometimes present with abdominal pain, nausea, and vomiting. However, the presence of fever and significant leukocytosis is less typical for pre-eclampsia alone.
- Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant pain, but it can occasionally refer pain to the left side. Fever and leukocytosis are common, but the absence of specific symptoms like jaundice or a palpable gallbladder makes this less likely.
Do Not Miss Diagnoses
- Appendicitis: Although the pain is typically in the right lower quadrant, atypical presentations can occur, especially in pregnant women where the appendix can be displaced upwards due to the enlarged uterus. Missing appendicitis can lead to severe consequences, including perforation and peritonitis.
- Placental Abruption: This condition, where the placenta separates from the uterus, can cause abdominal pain, vomiting, and fever, along with a risk of severe maternal and fetal distress. The presence of flank pain and urinary findings might distract from this diagnosis, but it's crucial to consider due to its potential severity.
- Sepsis: Any infection, including pyelonephritis or others, can lead to sepsis, a life-threatening condition. Early recognition and treatment of sepsis are critical to prevent high morbidity and mortality.
Rare Diagnoses
- Hepatic Rupture or Infarct: These are rare but serious conditions that can cause abdominal pain and systemic symptoms. They are more commonly associated with specific risk factors like pre-eclampsia or certain coagulopathies.
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain, nausea, and vomiting. While it's less common in pregnancy, it can be triggered by gallstones or other factors and should be considered in the differential diagnosis due to its potential severity.