Differential Diagnosis for Chronic Anal Fissures, Tenesmus, Post-Prandial Abdominal Distension and Pain, GERD, and Fatigue
- Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): This condition is characterized by chronic abdominal pain, bloating, and alteration of bowel habits, which aligns with the symptoms of post-prandial abdominal distension, pain, and tenesmus. While IBS does not directly cause anal fissures, the straining during bowel movements can contribute to their development. GERD can coexist with IBS, and fatigue is a common complaint among IBS patients.
- Other Likely Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic anal fissures, tenesmus, abdominal pain, and fatigue. Although IBD is less common than IBS, the presence of chronic anal fissures and significant gastrointestinal symptoms warrants consideration.
- Gastroesophageal Reflux Disease (GERD) with complications: While GERD is mentioned as a symptom, it's possible that the patient has complications of GERD, such as esophagitis or stricture, which could contribute to the overall clinical picture.
- Functional Dyspepsia: This condition involves chronic upper abdominal symptoms, such as pain or discomfort, which could contribute to post-prandial abdominal distension and pain.
- Do Not Miss Diagnoses
- Colorectal Cancer: Although less likely in younger patients, colorectal cancer can cause chronic anal fissures, tenesmus, abdominal pain, and fatigue. It's essential to rule out this diagnosis, especially if there are other risk factors or alarming symptoms like weight loss or rectal bleeding.
- Infections (e.g., Clostridioides difficile, parasitic infections): Certain infections can cause chronic gastrointestinal symptoms, including abdominal pain, tenesmus, and fatigue. These infections can be severe and require prompt treatment.
- Ischemic Bowel Disease: This condition involves reduced blood flow to the intestines, which can cause chronic abdominal pain, tenesmus, and fatigue. It's more common in older patients or those with cardiovascular risk factors.
- Rare Diagnoses
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause chronic abdominal pain, tenesmus, and fatigue.
- Mastocytic Enterocolitis: A condition involving mast cell infiltration of the gastrointestinal tract, leading to chronic abdominal pain, tenesmus, and fatigue.
- Chronic Intestinal Pseudo-Obstruction: A rare disorder characterized by impaired intestinal motility, which can cause chronic abdominal pain, tenesmus, and fatigue.