CASE 45
A 54-year-old woman presented to her family physician complaining of abdominal pain that had been worsening for the past 2 weeks. She stated that it often improved immediately after meals or taking antacids. She also noted occasional heartburn but denied fevers, nausea or vomiting, diarrhea, or bloody stools.
LABORATORY STUDIES
Diagnostic Work-Up
Table 45-1 lists the likely causes of illness (differential diagnosis). A clinical diagnosis of peptic ulcer disease was considered. Investigational approach may include
Rationale: Abdominal pain has an extremely broad differential diagnosis list. Certain features often help in determining which is the most likely etiology. Lower-right quadrant pain suggests appendicitis, whereas upper-right quadrant pain is suggestive of cholecystitis or cholelithiasis. The absence of diarrhea or emesis makes gastroenteritis and Crohn disease unlikely. Esophagitis or reflux disease would likely have chest pain as a prominent symptom. Pain associated with signs of acid hypersecretion suggests peptic ulcer disease. However, these are generalizations, and other factors, such as lab results and endoscopy, must also be considered.