Question

Ms B, a 42-year-old obese white female, presents to the clinic with cc of intermittent upper abdominal pain that comes and goes. States that she has had similar sx over the last 6 months, she has noticed that the pain is worse after she eats a large meal. She denies injury, denies hx of same/similar sx before this period over the last 6 months. She denies known sick contacts. She identifies that the pain occurs between her umbilicus and xiphoid process, sometimes it radiates through to her mid-back like she is being stabbed there. She denies chest pain, SOB but admits to associated nausea and vomiting, denies that vomiting relieves her symptoms. She is concerned because her father died of pancreatic cancer when he was in his 50s, she doesn't want to think that's what's wrong with her so she hasn't come to have it checked until now but "it's getting too bad to ignore." She also admits that her sister and her aunt have had their gallbladders out due to gallstones, and they both told her they think that's what is wrong with her.

She is married and lives locally with her husband and children in a single-family home. She works part-time in a local retail establishment and her hours are flexible so that she can be available to help with her children. She admits to regular ETOH consumption, smokes 1/2 ppd cigarettes but denies illicit drugs.   States that she drinks 2-3 mixed drinks every evening and has for the last 15 + years.

Her only surgical history includes a tonsillectomy at age 7 and three c-sections that were 10, 13, and 16 years PTA. She has a hx of hyperlipidemia, hypertension and is "pre-diabetic;" she is supposed to be working to reduce her weight and quit smoking to help alleviate her mild HTN and hyperlipidemia by going on a low-fat, low-cholesterol diet but states that she isn't consistent with that dietary recommendation.

NKDA

VS: BP 145/92   RR: 16    HR: 93      O2 sat 99% on RA   T 97.9F oral   Ht: 66" Wt: 197#

WDWNWA obese white female, appears stated age

what are the top 5 differential diagnosis of this patient.

Answer 1

Differential diagnosis can be

1.Fatty liver disease

According to the case study patient is obese,hypertensive,hyperlipidemic ,vomiting and intermittent pain may lead to fatty liver disease.

2.Pancreatic cancer

She has family history of pancreatic cancer

Pain in back regions

Smoking history

All these factors may suggest another differential diagnosis.

3.Gastritis

Pain in upper abdomonal region,vomiting and history of alcoholism

4 . Gall bladder stones:As per her case note her sisters had gallstones.

risk factors are she is obese,female gender,hyperlipidemic

Symptoms are vomiting,stomach pain

5.Pancreatitis

Following are risk factors

smoking,alcohol cosumption,,diabetic

according to the case note she is a smoker,alcoholic and pre diabetic