Differential Diagnosis for Severe Epigastric Pain
Single Most Likely Diagnosis
- Acute Pancreatitis: This is often the first consideration for severe epigastric pain, especially if it radiates to the back and is accompanied by nausea and vomiting. The pain typically starts abruptly and can be constant.
Other Likely Diagnoses
- Peptic Ulcer Disease: Both gastric and duodenal ulcers can cause severe epigastric pain, which may be exacerbated by eating or relieved by antacids.
- Gastroesophageal Reflux Disease (GERD): While typically causing a burning sensation, severe cases of GERD can lead to intense epigastric pain.
- Cholecystitis: Inflammation of the gallbladder can cause severe right upper quadrant pain that may radiate to the epigastric area.
Do Not Miss Diagnoses
- Myocardial Infarction: Although chest pain is the hallmark, myocardial infarctions can occasionally present with epigastric pain, especially in women or diabetic patients.
- Aortic Dissection: Severe, tearing pain that can start in the chest and radiate to the back or abdomen, including the epigastric area.
- Pulmonary Embolism: While typically presenting with respiratory symptoms, a pulmonary embolism can cause sudden, severe chest pain that might be referred to the epigastric area in some cases.
- Esophageal Rupture: A medical emergency that can cause severe chest or epigastric pain, often accompanied by difficulty swallowing or breathing.
Rare Diagnoses
- Pancreatic Cancer: Can cause epigastric pain, but it's less common and usually accompanied by other symptoms like weight loss and jaundice.
- Splenic Infarction or Rupture: Can cause severe left upper quadrant pain that might radiate to the epigastric area, often associated with trauma or underlying conditions like sickle cell disease.
- Mesenteric Ischemia: A rare condition where the blood flow to the intestines is blocked, causing severe abdominal pain, including the epigastric area, which is out of proportion to the physical examination findings.