Differential Diagnosis for 19 y.o. Patient
The patient presents with vomiting, diarrhea, and left lower quadrant (LLQ) pain, which suggests a gastrointestinal issue. Here's a differential diagnosis organized into categories:
- Single most likely diagnosis
- Gastroenteritis: This is the most likely diagnosis given the patient's symptoms of vomiting, diarrhea, and abdominal pain. The fact that she had a migraine and was vomiting 6 days ago, but then felt better before the symptoms recurred, suggests a possible viral or bacterial infection.
- Other Likely diagnoses
- Viral gastroenteritis (e.g., norovirus, rotavirus): These viruses can cause severe vomiting and diarrhea, and the patient's symptoms of hourly vomiting and diarrhea are consistent with this diagnosis.
- Food poisoning: The patient's symptoms could be due to food poisoning, especially if she consumed contaminated food or water.
- Irritable bowel syndrome (IBS): Although less likely, IBS could be a consideration, especially if the patient has a history of abdominal pain and altered bowel habits.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the patient's pain is in the LLQ, appendicitis is a possibility, especially if the appendix is retrocecal. Missing this diagnosis could lead to perforation and peritonitis.
- Intussusception: This is a rare condition where the intestine telescopes into itself, causing bowel obstruction and ischemia. It's more common in children, but can occur in adults, especially if there's a lead point such as a tumor.
- Ovarian torsion: This is a surgical emergency that can cause severe abdominal pain, nausea, and vomiting. Although less likely, it's essential to consider this diagnosis, especially if the patient has a history of ovarian cysts or tumors.
- Rare diagnoses
- Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis): These conditions can cause chronic abdominal pain, diarrhea, and weight loss, but are less likely given the acute presentation.
- Mesenteric lymphadenitis: This is a rare condition that causes abdominal pain, nausea, and vomiting, often due to viral or bacterial infection.
- Diverticulitis: Although more common in older adults, diverticulitis can occur in younger patients, especially if they have a history of diverticulosis.