Differential Diagnosis for Left Hypochondrium or Lower Rib Cage Pain
Single most likely diagnosis
- Gastroesophageal Reflux Disease (GERD): The pain being aggravated by eating and associated with bloating suggests a gastrointestinal origin. GERD is common and can cause sharp or dull pain in the lower chest or upper abdomen, which can radiate to the left hypochondrium.
Other Likely diagnoses
- Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause pain that worsens with eating, especially if the pain is related to gastric acid production. Bloating can also be present due to associated dyspepsia.
- Functional Dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can include pain or discomfort in the upper abdomen, bloating, and discomfort that worsens with eating.
- Irritable Bowel Syndrome (IBS): While IBS typically presents with abdominal pain and changes in bowel habits, some patients may experience upper abdominal symptoms, including bloating and discomfort that could be referred to the left hypochondrium.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial Infarction: Although less common, cardiac causes of chest pain can sometimes present atypically, especially in women, with pain referred to the upper abdomen or left hypochondrium. It's crucial to consider and rule out cardiac causes, especially if there are associated symptoms like shortness of breath or radiating pain.
- Pulmonary Embolism: Similar to myocardial infarction, pulmonary embolism can present with atypical symptoms, including sharp chest pain that could be referred to the left hypochondrium, especially if the embolism involves the lower lobes of the lung.
- Splenic Infarction or Rupture: These conditions can cause severe left upper quadrant pain and are emergencies. Splenic infarction might occur in the context of sickle cell disease, vasculitis, or thrombophilia, while rupture could be traumatic or spontaneous.
Rare diagnoses
- Pancreatitis: While pancreatitis typically causes severe, constant pain in the upper abdomen that radiates to the back, it's less common for it to present with pain localized to the left hypochondrium. However, it's a diagnosis that should be considered, especially if there's a history of gallstones or alcohol abuse.
- Gastric Cancer: This is a rare cause of upper gastrointestinal symptoms, including pain and bloating, but it's essential to consider in patients with risk factors (e.g., family history, previous gastric surgery) or those who do not respond to initial treatments for more common conditions.
- Splenic Flexure Syndrome: This condition involves gas entrapment in the splenic flexure of the colon, leading to left upper quadrant pain. It's relatively rare and often associated with constipation or other bowel habits changes.