Differential Diagnosis for Chronic Anal Fissures, Tenesmus, Post-Prandial Abdominal Distension and Pain, and GERD
Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): This diagnosis is likely due to the combination of chronic abdominal pain, post-prandial abdominal distension, and alteration in bowel habits (tenesmus). Although IBS does not typically cause anal fissures, the presence of other symptoms aligns closely with IBS, and anal fissures can occur independently.
Other Likely Diagnoses
- Inflammatory Bowel Disease (IBD): Given the symptoms of chronic anal fissures, tenesmus, and abdominal pain, IBD (including Crohn's disease and ulcerative colitis) is a plausible diagnosis. IBD can cause a wide range of gastrointestinal symptoms, including those mentioned.
- Gastroesophageal Reflux Disease (GERD) with associated dyspepsia: While GERD is already mentioned, its combination with dyspepsia could explain post-prandial abdominal distension and pain.
- Functional dyspepsia: This condition involves recurring symptoms of upper abdominal pain or discomfort not exclusively related to defecation, which could contribute to the post-prandial symptoms.
Do Not Miss Diagnoses
- Colorectal Cancer: Although less likely in younger patients, colorectal cancer can present with anal fissures, changes in bowel habits, and abdominal pain. It's crucial to rule out this diagnosis, especially if there's a family history or other risk factors.
- Infectious Colitis: Certain infections can cause chronic symptoms similar to IBD, including tenesmus and abdominal pain. Identifying and treating the underlying infection is critical.
- Ischemic Bowel Disease: This condition, often seen in older patients or those with vascular disease, can cause chronic abdominal pain and changes in bowel habits.
Rare Diagnoses
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, leading to various symptoms including abdominal pain and dyspepsia.
- Gastroparesis: A condition where the stomach takes too long to empty its contents, which can cause post-prandial fullness, nausea, and abdominal pain.
- Intestinal Obstruction: Although typically presenting acutely, partial or intermittent obstruction could lead to chronic symptoms of abdominal pain and distension.
- Celiac Disease: An autoimmune reaction to gluten, leading to small intestine damage and a variety of gastrointestinal symptoms, including abdominal pain and changes in bowel habits.