Differential Diagnosis for 79F with Lower Abdominal Pain
The patient presents with a history of diverticulitis and current left lower abdominal pain, which guides the differential diagnosis. Consideration of her recent knee replacement, hypothyroidism, and hypertension is also crucial.
Single Most Likely Diagnosis
- Diverticulitis: Given the patient's history of diverticulitis and the location of her pain (left lower abdominal pain), this is the most likely diagnosis. Diverticulitis typically presents with abdominal pain, usually on the left side, and can be accompanied by changes in bowel habits, fever, and nausea.
Other Likely Diagnoses
- Constipation: Common in elderly patients and those with a history of diverticulitis, constipation can cause significant abdominal pain and discomfort.
- Gastroenteritis: Infection of the stomach and intestines, which can cause abdominal pain, diarrhea, and vomiting.
- Irritable Bowel Syndrome (IBS): Although less likely given the acute presentation, IBS can cause chronic abdominal pain and changes in bowel habits.
- Adhesions or Bowel Obstruction: Possible complications from previous surgeries, including her recent knee replacement or any abdominal surgery, which can cause bowel obstruction leading to severe abdominal pain.
Do Not Miss Diagnoses
- Appendicitis: Although the pain is on the left side, appendicitis can occasionally present with pain in this location, especially if the appendix is retrocecal. Missing this diagnosis could lead to perforation and severe consequences.
- Ectopic Pregnancy: Extremely unlikely given the patient's age but should be considered in any female patient of childbearing age with abdominal pain.
- Ovarian Torsion: A rare but serious condition that can cause severe abdominal pain and requires immediate attention.
- Mesenteric Ischemia: A condition where there's insufficient blood flow to the intestines, which can cause severe abdominal pain and is life-threatening if not promptly treated.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain and changes in bowel habits but are less common in new presentations at this age.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause abdominal pain and is more common in children but can occur in adults.
- Colonic Volvulus: A condition where the colon twists around itself and its mesentery, cutting off the blood supply, which can cause severe abdominal pain and constipation.