Differential Diagnosis for Sudden Onset LLQ Pain, Nausea, Vomiting, and Dysuria in a 15-year-old Female on Birth Control
- Single Most Likely Diagnosis
- Ovarian Cyst or Torsion: The patient's symptoms, including sudden onset lower left quadrant (LLQ) pain, nausea, and vomiting, are consistent with ovarian cyst or torsion, especially given her age and use of birth control, which can increase the risk of ovarian cysts.
- Other Likely Diagnoses
- Urinary Tract Infection (UTI): Dysuria (painful urination) is a key symptom of UTIs, which are common in females and can cause lower abdominal pain, nausea, and vomiting.
- Appendicitis: Although appendicitis typically presents with right lower quadrant pain, it can occasionally present atypically, especially in females, and should be considered in the differential diagnosis for acute abdominal pain.
- Ectopic Pregnancy: Despite being on birth control, the possibility of pregnancy should not be overlooked, especially if the birth control method has a failure rate or if there was non-adherence. Ectopic pregnancy is a serious condition that can present with abdominal pain and vomiting.
- Do Not Miss Diagnoses
- Ruptured Ectopic Pregnancy: This is a life-threatening condition that requires immediate medical attention. Even if the patient is on birth control, the possibility of a ruptured ectopic pregnancy must be considered due to its high mortality rate if missed.
- Ovarian Torsion: While listed as the most likely diagnosis, it's also crucial under "Do Not Miss" because timely intervention is necessary to preserve ovarian function and prevent complications.
- Appendiceal Rupture: If appendicitis is present and the appendix ruptures, it can lead to severe peritonitis and sepsis, making prompt diagnosis and treatment critical.
- Rare Diagnoses
- Diverticulitis: Although more common in older adults, diverticulitis can occur in younger individuals and presents with abdominal pain, often in the lower left quadrant, along with changes in bowel habits and possible nausea and vomiting.
- Endometriosis: This condition can cause chronic pelvic pain but may also have acute exacerbations leading to severe pain, nausea, and vomiting, especially during menstruation or if an endometrioma ruptures.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause abdominal pain, vomiting, and sometimes dysuria if the intussusception involves the lower parts of the intestine. It's more common in younger children but can occur in adolescents.