Differential Diagnosis for Lisa's Abdominal Pain
Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): Given Lisa's history of diverticulitis and her current symptoms of generalized abdominal pain without any changes in bowel habits, IBS is a plausible diagnosis. The pain's description as a dull ache and its unpredictable nature also align with IBS.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Although Lisa denies chest pain, GERD can sometimes present with epigastric pain that radiates to the right middle abdomen. Her avoidance of triggers like nuts could be related to exacerbating GERD symptoms.
- Peptic Ulcer Disease: The upper epigastric pain could be indicative of a peptic ulcer, especially if Lisa has been experiencing stress or has a history of NSAID use, which she didn't mention but could be a factor.
- Functional Dyspepsia: This condition involves recurring or persistent upper abdominal pain or discomfort that is not explained by other conditions. Lisa's symptoms of dull ache in the upper epigastric area could fit this diagnosis.
Do Not Miss Diagnoses
- Appendicitis: Although Lisa's pain started in the upper epigastric area and moved to the right middle abdomen, which is atypical for appendicitis, it's crucial not to miss this diagnosis due to its potential for severe complications if not treated promptly.
- Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant pain, which might radiate to the middle abdomen. It's essential to consider this, especially if Lisa has a history of gallstones or has experienced similar pain in the past.
- Pancreatitis: Acute or chronic pancreatitis could present with upper abdominal pain radiating to the back or right side, although Lisa's symptoms are not typical. It's a critical diagnosis not to miss due to its potential severity.
Rare Diagnoses
- Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis): While Lisa denies changes in bowel habits, which are common in IBD, it's possible for these conditions to present with abdominal pain as a primary symptom, especially if the disease is limited to the upper GI tract.
- Abdominal Malignancy: Although rare, it's essential to consider the possibility of abdominal cancer, such as gastric, pancreatic, or intestinal cancer, especially if Lisa has risk factors like a family history or has been experiencing unexplained weight loss, which she didn't mention.