Being able to distinguish acute pancreatitis from other conditions is key to providing crucial treatment within a timely fashion. Listed below are a number of conditions that can present themselves similarly to acute pancreatitis:
- Acute Mesenteric Ischemia
- Acute Peritonitis
- Appendicitis
- Bacterial Pneumonia
- Cholecystitis and/or Cholelithiasis (gallstones)
- Myocardial Infarction
- Peptic Ulcer Disease
- Viral Hepatitis
In the described patient, differential diagnoses can include: Appendicitis, Cholecystitis, and Pancreatitis.
Differential Diagnosis 1 : Appendicitis
(The Awkward Yeti [theawkwardyeti], 2013)
Appendicitis : Although the exact cause of appendicitis is unknown, it results from increased pressure that decreases the mucosal blood flow causing the appendix to become hypoxic. Clinical manifestations of appendicitis typically include: epigastric pain, rebound tenderness, nausea, and vomiting . Findings from further testing, such as CT scan, WBC count between 10,000-16,000 cells/mm3, and ultrasound can be used to distinguish appendicitis from other diagnoses. (McCance & Huether, 2014).
This differential diagnosis is compatible with Mr. Walker because he describes his abdominal pain as being central with the pain radiating towards his back, he has vomited several times, and presents with abdominal guarding and rebound tenderness. During his physical exam, Mr. Walker has a low-grade fever and describes his pain as being 8 out of 10 which are also commonly seen in patients with appendicitis.
Differential Diagnosis 2 : Cholecystitis
(The Awkward Yeti [theawkwardyeti], 2015)
Cholecystitis: Cholecystitis is typically the result of a gallstone becoming lodged in the cystic duct. This blockage causes the gallbladder to become distended and inflamed. Common clinical manifestations of cholecystitis include: fever, rebound tenderness, and abdominal muscle guarding. Further testing can be completed to differentiate cholecystitis from other diagnoses, which is extremely important due to the complications that can arise from untreated cholecystitis. Test results may include: elevated serum bilirubin and/or elevated alkaline phosphatase. (McCance & Huether, 2014).
This differential diagnosis is compatible with Mr. Walker because of the abdominal pain he has described, along with the rebound tenderness and guarding found on physical examination. Furthermore, Mr. Walker has an extensive family history of gallstones involving his siblings and his mother.
Differential Diagnosis 3 : Pancreatitis
(The Awkward Yeti [theawkwardyeti], 2012)
Pancreatitis : Pancreatitis is an obstructive disease that occurs when the outflow of digestive enzymes are blocked. This obstruction results in the release of enzymes which cause auto digestion of cells and tissues. This auto digestion results in inflammation and edema within the pancreas. Common clinical manifestations of pancreatitis include: mid abdominal pain that radiates towards the back, fever, and vomiting. Further testing that can be completed after initial exam are CT scans and blood work. The primary diagnostic marker for pancreatitis is elevated serum lipase levels. (McCance & Huether, 2014).
Due to Mr. Walker presenting with midepigastric pain that radiates towards his back, the cardinal sign of pancreatitis, this diagnosis is compatible. Mr. Walker also presents with a low grade fever and persistent vomiting which are common signs/symptoms of acute pancreatitis.
Next up: Let’s look at our further test results and discuss the correct diagnosis for Mr. Walker