Differential Diagnosis for Abdominal Pain
The patient presents with abdominal pain, nausea, emesis, and a diffusely tender abdomen. The abdominal X-ray results are not provided, but based on the symptoms, we can formulate a differential diagnosis.
- Single most likely diagnosis
- Small bowel obstruction: The patient's symptoms of intermittent, intense, cramping abdominal pain, nausea, emesis, and lack of bowel movements or flatus are consistent with a small bowel obstruction. The physical exam findings of a distended and tympanitic abdomen also support this diagnosis.
- Other Likely diagnoses
- Sigmoid volvulus: This condition can cause similar symptoms, including abdominal pain, nausea, and vomiting. However, it is less likely than small bowel obstruction given the patient's diffuse abdominal tenderness and lack of specific symptoms pointing to sigmoid involvement.
- Cecal volvulus: Although less common, cecal volvulus can also present with abdominal pain, nausea, and vomiting. The patient's symptoms and physical exam findings could be consistent with this diagnosis, but it is less likely than small bowel obstruction.
- Adynamic ileus: This condition is characterized by a lack of bowel movements and can cause abdominal distension and tenderness. However, it typically does not cause the intense, cramping pain described by the patient.
- Do Not Miss diagnoses
- Mesenteric ischemia: Although less likely, mesenteric ischemia is a life-threatening condition that can present with abdominal pain, nausea, and vomiting. It is essential to consider this diagnosis, especially if the patient has risk factors such as atrial fibrillation or a history of embolic events.
- Appendicitis: Although the patient's symptoms are not typical for appendicitis, it is a condition that should not be missed, especially if the patient has a history of abdominal surgery, which can increase the risk of appendicitis.
- Rare diagnoses
- Intussusception: This condition is rare in adults and typically presents with abdominal pain, nausea, and vomiting. However, it is less likely given the patient's symptoms and physical exam findings.
- Abdominal hernia: Although possible, an abdominal hernia is less likely given the patient's symptoms and lack of specific findings on physical exam.