Differential Diagnosis for Abdominal Pain after Eating, Left Sided, Radiating to Left Shoulder Blade
- Single Most Likely Diagnosis
- Peptic Ulcer Disease: The pain after eating and radiation to the left shoulder blade (referred pain due to the shared nerve roots) is consistent with peptic ulcer disease, particularly a duodenal ulcer. The location and nature of the pain, along with its relation to meals, support this diagnosis.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): While GERD typically presents with heartburn and regurgitation, some patients may experience abdominal pain that radiates to the back, including the shoulder area, due to esophageal irritation.
- Pancreatitis: Acute or chronic pancreatitis can cause severe abdominal pain that radiates to the back. The pain is often constant and may worsen after eating, especially fatty foods.
- Cholecystitis or Cholelithiasis: Gallbladder inflammation or stones can cause right upper quadrant pain, but in some cases, the pain can be more diffuse or even left-sided, especially if a stone obstructs the ampulla of Vater, causing pancreatitis.
- Do Not Miss Diagnoses
- Myocardial Infarction: Although less common, myocardial infarction can present with epigastric pain or discomfort that radiates to the back, including the shoulder area. This is a critical diagnosis not to miss due to its high mortality if untreated.
- Aortic Dissection: Severe, tearing chest pain that radiates to the back can be a sign of an aortic dissection, a life-threatening condition requiring immediate intervention.
- Pulmonary Embolism: While typically presenting with respiratory symptoms, a pulmonary embolism can cause chest pain that radiates to the shoulders or back, especially if it involves the lung periphery.
- Rare Diagnoses
- Splenic Infarction or Rupture: These conditions can cause left upper quadrant pain that radiates to the left shoulder due to the proximity of the spleen to the diaphragm and the resulting referred pain.
- Diaphragmatic Irritation (e.g., from a subphrenic abscess): Inflammation or irritation of the diaphragm can cause abdominal pain that radiates to the shoulder due to shared nerve roots.
- Gastric Cancer: Although rare, gastric cancer can present with abdominal pain that worsens after eating, among other symptoms like weight loss and difficulty swallowing.