Differential Diagnosis for Severe Epigastric Abdominal Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD) or Peptic Ulcer Disease: The severe epigastric pain following a meal could be indicative of GERD or peptic ulcer disease, especially given the normal labs and the presence of stool in the ascending colon, which doesn't immediately suggest an intestinal obstruction.
Other Likely Diagnoses
- Acute Cholecystitis: Although the pain is described as epigastric, acute cholecystitis can sometimes present with pain in this region, especially if the gallbladder is inflamed and irritating the surrounding tissues.
- Acute Pancreatitis: This condition can cause severe epigastric pain that radiates to the back, and while the labs are normal, early in the course of the disease, lab values might not be elevated.
- Food Poisoning or Gastroenteritis: Severe abdominal pain following a meal could be due to food poisoning or a viral gastroenteritis, especially if the patient recently consumed contaminated food or has been exposed to someone with similar symptoms.
Do Not Miss Diagnoses
- Myocardial Infarction: Although the pain is epigastric and follows a meal, it's crucial not to miss a myocardial infarction, as cardiac pain can sometimes be referred to the epigastric region.
- Aortic Dissection: This is a life-threatening condition that can cause severe, tearing chest pain but can also present with abdominal pain if the dissection involves the abdominal aorta.
- Mesenteric Ischemia: This condition, which involves insufficient blood flow to the intestines, can cause severe abdominal pain out of proportion to the physical examination findings and can be a diagnosis that is easily missed.
Rare Diagnoses
- Intestinal Obstruction: Although the X-ray shows stool in the ascending colon, which might argue against a complete obstruction, a partial obstruction or an early obstruction could still present with severe pain and relatively normal initial imaging.
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause abdominal pain, nausea, and vomiting.
- Abdominal Migraine: A condition that can cause severe, episodic abdominal pain, often accompanied by other migraine symptoms like headache or nausea.