Differential Diagnosis for 80 y/o Male with Abdominal Pain and Hypotension
Single Most Likely Diagnosis
- Hemorrhagic shock due to ruptured abdominal aortic aneurysm (AAA): The patient's age, abdominal pain, and hypotension (low blood pressure) are highly suggestive of a ruptured AAA, which is a medical emergency.
Other Likely Diagnoses
- Mesenteric ischemia: This condition, which involves insufficient blood flow to the intestines, can cause abdominal pain and hypotension, especially in elderly patients.
- Sepsis due to intra-abdominal infection: Elderly patients are more susceptible to infections, and an intra-abdominal infection (e.g., diverticulitis, cholecystitis) can lead to sepsis, which presents with abdominal pain and hypotension.
- Bowel obstruction: A bowel obstruction can cause abdominal pain and, if severe, lead to hypotension due to dehydration and electrolyte imbalances.
Do Not Miss Diagnoses
- Ectopic pregnancy (in a female patient, but included for completeness): Although the patient is male, it's essential to consider ectopic pregnancy in any patient with abdominal pain and hypotension, as it is a life-threatening condition.
- Ruptured ectopic liver or splenic abscess: These conditions are rare but can cause severe abdominal pain and hypotension.
- Toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS): These severe skin conditions can cause hypotension and abdominal pain due to systemic inflammation.
Rare Diagnoses
- Abdominal compartment syndrome: This condition, characterized by increased pressure within the abdominal cavity, can cause abdominal pain and hypotension.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, but in some cases, may present with hypotension due to catecholamine depletion.
- Intra-abdominal testicular torsion: A rare condition where the testicle twists, cutting off its blood supply, which can cause abdominal pain and, in severe cases, hypotension.