Differential Diagnosis for Midline Upper Abdominal Pain
Single Most Likely Diagnosis
- Constipation-related abdominal pain: Given the patient's history of severe constipation, it is plausible that the constant midline upper abdominal pain is related to constipation, possibly due to increased pressure on the abdominal wall or referred pain from the colon.
Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): Although the recent EGD was normal, GERD can still cause midline upper abdominal pain, especially if the patient has symptoms of acid reflux.
- Peptic ulcer disease: Despite a normal EGD, peptic ulcer disease is still a possibility, especially if the patient has a history of NSAID use or Helicobacter pylori infection.
- Functional dyspepsia: This is a common condition characterized by recurring upper abdominal pain or discomfort, which can be constant and midline.
Do Not Miss Diagnoses
- Pancreatitis: Although less likely, pancreatitis can cause midline upper abdominal pain and would be a critical diagnosis to miss, given its potential for severe complications.
- Gastric cancer: Although the EGD was normal, gastric cancer can still be a possibility, especially in older adults, and would be a critical diagnosis to miss.
- Small bowel obstruction: Given the patient's history of cholecystectomy, adhesions could be a possible cause of small bowel obstruction, which would require prompt surgical intervention.
Rare Diagnoses
- Gastric volvulus: A rare condition where the stomach twists abnormally, causing upper abdominal pain.
- Median arcuate ligament syndrome: A rare condition where the median arcuate ligament compresses the celiac artery, causing upper abdominal pain.
- Abdominal wall pain: A rare condition where the pain is referred from the abdominal wall itself, rather than an intra-abdominal organ.