Differential Diagnosis for Severe Stomach Pain
The patient presents with severe stomach pain that is worsening, which requires a thorough differential diagnosis to identify potential causes. The following categories outline possible diagnoses:
- Single most likely diagnosis
- Gastroenteritis: This is a common condition characterized by inflammation of the stomach and intestines, often caused by viral or bacterial infections. The symptoms of gastroenteritis, such as abdominal pain, nausea, vomiting, and diarrhea, align with the patient's complaint of severe stomach pain.
- Other Likely diagnoses
- Peptic Ulcer Disease: Stomach ulcers or duodenal ulcers can cause severe abdominal pain, especially if they perforate or bleed. The pain is often described as burning or gnawing and can be exacerbated by food.
- Gastritis: Inflammation of the stomach lining can cause pain, nausea, and vomiting. Gastritis can be acute or chronic and may be related to alcohol consumption, non-steroidal anti-inflammatory drugs (NSAIDs), or stress.
- Irritable Bowel Syndrome (IBS): Although IBS is a chronic condition, it can cause severe abdominal pain, bloating, and changes in bowel habits. However, the pain is often crampy and accompanied by other symptoms like diarrhea or constipation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the pain is typically localized to the right lower quadrant, appendicitis can present with generalized abdominal pain that worsens over time. Missing this diagnosis can lead to perforation and peritonitis.
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain, nausea, and vomiting. The pain is often radiating to the back and can be exacerbated by eating.
- Ectopic Pregnancy: In women of childbearing age, ectopic pregnancy is a life-threatening condition that can cause severe abdominal pain, vaginal bleeding, and shoulder pain.
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that radiates to the abdomen. This is a medical emergency that requires immediate attention.
- Rare diagnoses
- Intestinal Obstruction: A blockage in the intestines can cause severe abdominal pain, nausea, vomiting, and constipation. This condition requires prompt surgical intervention.
- Mesenteric Ischemia: Reduced blood flow to the intestines can cause severe abdominal pain, nausea, and vomiting. This condition is often seen in older adults and requires prompt medical attention.
- Gastric Cancer: Although rare, gastric cancer can cause severe abdominal pain, weight loss, and difficulty swallowing. This diagnosis should be considered in patients with risk factors, such as a family history or Helicobacter pylori infection.