Differential Diagnosis for Paraplegic Patient with Back, Flank, and Upper Left Abdominal Pain
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI) or Pyelonephritis: Given the patient's history of UTIs and indwelling catheter, a UTI or pyelonephritis is highly likely. The indwelling catheter increases the risk of bacterial colonization and infection, and the patient's symptoms of back, flank, and abdominal pain are consistent with an upper urinary tract infection.
Other Likely Diagnoses
- Kidney Stone: The patient's symptoms of flank and abdominal pain could be indicative of a kidney stone, especially if the stone is obstructing the ureter and causing pain.
- Autonomic Dysreflexia: This is a life-threatening medical emergency that can occur in patients with spinal cord injuries above T6. It is characterized by severe hypertension, bradycardia, and symptoms such as headache, sweating, and flushing above the level of the lesion. The patient's difficulty localizing pain due to paraplegia makes this diagnosis more challenging to identify.
- Constipation or Bowel Obstruction: Paraplegic patients are at increased risk of constipation and bowel obstruction due to neurogenic bowel. Abdominal pain and discomfort can be symptoms of these conditions.
Do Not Miss Diagnoses
- Septic Shock: If the patient's UTI or pyelonephritis has progressed to sepsis, it could be life-threatening. Early recognition and treatment of sepsis are crucial.
- Ruptured Visculature (e.g., Aortic Aneurysm or Ruptured Renal Artery Aneurysm): Although less likely, a ruptured aneurysm could present with severe back and abdominal pain and would be catastrophic if missed.
- Pulmonary Embolism: Paraplegic patients are at increased risk of deep vein thrombosis and pulmonary embolism due to immobility. While the symptoms may not be typical, it is essential to consider this diagnosis.
Rare Diagnoses
- Spinal Epidural Abscess: This is a rare but potentially life-threatening condition that can occur in patients with spinal cord injuries. It presents with back pain, fever, and neurological deficits.
- Tumor (e.g., Renal Cell Carcinoma): Although rare, a tumor could cause the patient's symptoms, especially if it is obstructing the ureter or invading surrounding structures.
- Pancreatitis: This could be a rare cause of the patient's abdominal pain, especially if there is a history of gallstones or other risk factors for pancreatitis.