Differential Diagnosis
- Single most likely diagnosis
- Constipation: Given the patient's age, history of diabetes, and symptoms of loss of appetite, abdominal cramps, and not having passed stool for 3 days, constipation is a highly plausible diagnosis. The epigastric tenderness could be related to the constipation or possibly an underlying gastrointestinal issue.
- Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): The epigastric tenderness and abdominal cramps could be indicative of GERD, especially in the context of the patient's age and comorbid conditions.
- Diverticulitis: Although less common in this age group without a history of diverticular disease, the abdominal cramps and constipation could suggest diverticulitis, particularly if the patient has a history of diverticulosis.
- Medication-induced gastrointestinal side effects: Given the patient's history of diabetes, hypertension, and atrial fibrillation, they are likely on multiple medications, some of which could cause gastrointestinal side effects such as constipation or abdominal pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Mesenteric ischemia: This is a critical diagnosis to consider, especially in a patient with atrial fibrillation, who is at increased risk of embolic events. Abdominal pain out of proportion to physical examination findings is a red flag for mesenteric ischemia.
- Bowel obstruction: Although less likely without a clear history of abdominal surgery or hernias, bowel obstruction could present with constipation, abdominal cramps, and vomiting, and is a medical emergency.
- Pancreatitis: Epigastric tenderness and abdominal cramps could be indicative of pancreatitis, especially if the patient has a history of gallstones or hypertriglyceridemia.
- Rare diagnoses
- Colorectal cancer: While less likely without a history of weight loss, changes in bowel habits, or iron-deficiency anemia, colorectal cancer could present with constipation and abdominal cramps in an elderly patient.
- Ischemic colitis: This condition could present with abdominal pain, constipation, and possibly bloody stools, and is more common in patients with atherosclerotic disease or atrial fibrillation.