Differential Diagnosis for 81 y.o. Female with Intermittent Abdominal Pain
Single Most Likely Diagnosis
- Diverticulitis: Given the patient's history of diverticulitis in 3/2021, the current symptoms of intermittent abdominal pain in the lower quadrants, bloating, and mild tenderness to palpation are consistent with a recurrence of diverticulitis. The recent activity and consumption of potentially irritating foods like Popeye's chicken may have triggered the symptoms.
Other Likely Diagnoses
- Irritable Bowel Syndrome (IBS) Exacerbation: The patient has a history of IBS, and the current symptoms of abdominal pain, bloating, and cramping could be an exacerbation of IBS, especially given the stress of recent activity and potentially irritating foods.
- Constipation: The patient reports being able to move bowels and pass gas, but the symptoms of bloating and abdominal pain could also be related to constipation, especially in an elderly patient with a history of osteoporosis and potential decreased mobility.
- Gastroesophageal Reflux Disease (GERD) Exacerbation: The patient has a history of GERD and recent hiatal hernia surgery, and the symptoms of abdominal pain and bloating could be related to an exacerbation of GERD.
Do Not Miss Diagnoses
- Appendicitis: Although the patient's symptoms are not typical for appendicitis (e.g., pain is not localized to the right lower quadrant and is intermittent), appendicitis is a potentially life-threatening condition that must be considered, especially in an elderly patient with abdominal pain.
- Bowel Obstruction: The patient's symptoms of abdominal pain, bloating, and fatigue could be related to a bowel obstruction, which is a medical emergency.
- Mesenteric Ischemia: The patient's age and history of hypertension and hyperlipidemia put her at risk for mesenteric ischemia, a potentially life-threatening condition that requires prompt diagnosis and treatment.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): Although the patient has a history of diverticulitis and IBS, the symptoms of abdominal pain, bloating, and fatigue could also be related to IBD, such as Crohn's disease or ulcerative colitis.
- Abdominal Aortic Aneurysm: The patient's age and history of hypertension put her at risk for an abdominal aortic aneurysm, which can cause abdominal pain and tenderness.
- Ovarian Torsion: Although rare in postmenopausal women, ovarian torsion can cause severe abdominal pain and must be considered in the differential diagnosis.