Question Five: Analysis of the Current Diagnosis and Differential Diagnoses

The patient presentations are consistent with acute pancreatitis. Acute pancreatitis presents with epigastric abdominal pain and is commonly accompanied by vomiting. Pain observed in acute pancreatitis is sharp, severe, and persistent and is made worse by the assumption of the supine position (Chatila et al., 2019). This diagnosis is confirmed by the failure of PPIs to relieve the patient’s manifestations. PPIs maintain effectiveness in gastric disorders such as PUD and GERD that have similar presentations as acute pancreatitis. A failed response to PPI may be indicative of acute pancreatitis.

Possible conditions that may be considered differential diagnoses for this patient include GERD, PUD, and gastric cancer. GERD, gastroesophageal reflux disease, often presents with a burning sensation in the lower retrosternal area and the epigastrium. This diagnosis is ruled out because of the additional manifestations of vomiting and pain radiating to the back that are not characteristic of the disease (Maret-Ouda et al., 2020). PUD presents with abdominal epigastric pain that radiates to the back and vomiting, as seen in the case (Malik et al., 2022). This diagnosis is, however, ruled out because of the failed response to PPIs. Gastric cancer has a similar presentation as PUD. However, it is defined by the presence of alarm symptoms such as melena stool and weight loss (Moala AlHazmi et al., 2021). Such is not the case in the patient case presented.

References

Chatila, A., Bilal, M., & Guturu, P. (2019). Evaluation and management of acute pancreatitis. World Journal of Clinical Cases, 7(9), 1006-1020. https://doi.org/10.12998/wjcc.v7.i9.1006