Differential Diagnosis
The patient's symptoms of frequent heartburn, constipation and diarrhea bouts, and malaise, combined with a Hida scan showing 95% gallbladder emptying, suggest a range of possible diagnoses. Here is a categorized differential diagnosis:
- Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): The patient's symptoms of constipation, diarrhea, and malaise are consistent with IBS, a common disorder characterized by abdominal pain and changes in bowel habits. The normal gallbladder emptying on the Hida scan makes gallbladder disease less likely.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): The patient's heartburn symptoms suggest GERD, a condition in which stomach acid flows back into the esophagus, causing discomfort.
- Functional Dyspepsia: This condition is characterized by recurring signs and symptoms of indigestion that have no obvious cause, which could contribute to the patient's malaise and gastrointestinal symptoms.
- Small Intestine Bacterial Overgrowth (SIBO): This condition, where bacteria overgrow in the small intestine, can cause symptoms similar to IBS, including bloating, abdominal pain, diarrhea, and constipation.
- Do Not Miss Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic diarrhea, abdominal pain, and weight loss, and would be critical to diagnose due to their potential for serious complications.
- Celiac Disease: An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine, causing symptoms like diarrhea, abdominal pain, and malabsorption.
- Gastric Cancer: Although less likely, gastric cancer can present with nonspecific symptoms like heartburn, abdominal discomfort, and changes in bowel habits, making it essential not to miss.
- Rare Diagnoses
- Whipple's Disease: A rare, systemic bacterial infection that can cause malabsorption, weight loss, and gastrointestinal symptoms.
- Eosinophilic Gastroenteritis: A rare condition characterized by the presence of eosinophils in the gastrointestinal tract, leading to symptoms like abdominal pain, diarrhea, and weight loss.
- Mastocytosis: A condition where mast cells accumulate in one or more organs, including the gastrointestinal tract, potentially causing symptoms like diarrhea, abdominal pain, and flushing.