Differential Diagnosis for 21-year-old Male with Left Upper Quadrant Pain
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): Given the symptoms of nausea, vomiting, and left upper quadrant pain, GERD is a plausible diagnosis, especially if the patient experiences worsening symptoms after eating or at night. The normal CT abdomen reduces the likelihood of other structural causes.
Other Likely Diagnoses
- Peptic ulcer disease: Although the patient denies drug use, stress or other factors could contribute to peptic ulcer disease, which could cause left upper quadrant pain, nausea, and vomiting.
- Gastritis: Inflammation of the stomach lining could be due to various causes, including stress, and could present with similar symptoms.
- Functional dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause, which could fit the patient's presentation.
Do Not Miss Diagnoses
- Splenic infarct or rupture: Although the CT abdomen is normal, it's crucial to consider splenic issues, especially if the patient has a history of trauma or conditions that could lead to splenic infarction or rupture, as these are medical emergencies.
- Pancreatitis: Despite the absence of alcohol or drug use, pancreatitis can occur due to other causes (e.g., gallstones, genetic conditions), and it's essential to rule out this potentially life-threatening condition.
- Ectopic pregnancy-related complications (if applicable): Although less likely in a male patient, if there's any possibility of an ectopic pregnancy (e.g., in a patient with a female partner), it's crucial to consider this due to its high mortality rate if missed.
Rare Diagnoses
- Splenic cyst or abscess: These conditions could cause left upper quadrant pain but are less common and might not be immediately suspected without specific risk factors or imaging findings suggestive of these conditions.
- Left-sided diaphragmatic hernia: A rare condition where abdominal contents herniate through the diaphragm, potentially causing upper quadrant pain and gastrointestinal symptoms.
- Gastric volvulus: A rare condition where the stomach twists abnormally, which could cause severe upper abdominal pain, nausea, and vomiting.