Differential Diagnosis for Severe Epigastric Pain, Fever, and Loss of Liver Dullness
- Single Most Likely Diagnosis
- Perforated viscus: The combination of severe epigastric pain, fever, loss of liver dullness (suggesting free air under the diaphragm), and mild leucocytosis points strongly towards a perforated viscus. This condition is a surgical emergency and fits well with the symptoms described.
- Other Likely Diagnoses
- Diverticulitis: While less likely than a perforated viscus given the loss of liver dullness, diverticulitis can cause severe abdominal pain, fever, and leucocytosis. It's a consideration, especially if the patient has a history of diverticular disease.
- Chilaiditi syndrome: This syndrome involves the interposition of the colon between the liver and the diaphragm, which can cause abdominal pain and potentially mimic the loss of liver dullness. However, it's less likely to cause fever and leucocytosis.
- Do Not Miss Diagnoses
- Liver abscess: Although liver abscesses can cause fever and abdominal pain, they typically do not result in the loss of liver dullness. However, a large abscess could potentially cause significant symptoms and would be critical not to miss due to the need for specific treatment.
- Chronic DU (Duodenal Ulcer) with perforation: While chronic DU is less likely to present acutely with these symptoms, if a chronic DU were to perforate, it would present similarly to a perforated viscus and is thus a critical diagnosis not to miss.
- Rare Diagnoses
- Other rare causes of pneumoperitoneum: Conditions such as pneumatosis cystoides intestinalis or gas-producing bacterial infections could potentially cause some of these symptoms but are much less common and would be considered only after more likely diagnoses have been ruled out.