Differential Diagnosis for 75 YR OLD LADY with Spasma Lower Abd Supra Pubic RT Sided
- The patient's symptoms include spasms in the lower abdominal area, specifically supra pubic right sided, occurring only at night, accompanied by bloating and constipation.
Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): The patient's symptoms of abdominal spasms, bloating, and constipation, particularly occurring at night, are consistent with IBS. The condition is common in the elderly and can be exacerbated by various factors, including diet and stress.
Other Likely Diagnoses
- Constipation: Given the patient's complaint of constipation, it's possible that the abdominal spasms and bloating are secondary to constipation. The supra pubic location of the pain could indicate a full bladder or rectum.
- Diverticulitis: Although less common in this presentation, diverticulitis could cause lower abdominal pain, particularly if the diverticula are located in the sigmoid colon, which is common in the elderly. However, the absence of fever and changes in bowel habits makes this less likely.
- Gastroesophageal Reflux Disease (GERD): While GERD typically presents with upper abdominal or chest symptoms, some patients may experience lower abdominal discomfort, especially if there is associated constipation or bloating.
Do Not Miss Diagnoses
- Ovarian Torsion: Although rare, ovarian torsion is a surgical emergency that can present with sudden onset of severe lower abdominal pain, often accompanied by nausea and vomiting. The patient's age and the acute onset of symptoms at night necessitate consideration of this diagnosis.
- Appendicitis: While the classic presentation of appendicitis includes migration of pain from the periumbilical area to the right lower quadrant, atypical presentations can occur, especially in the elderly. The presence of right-sided lower abdominal pain warrants consideration of appendicitis.
- Intestinal Obstruction: This condition can cause severe abdominal pain, bloating, and constipation. The patient's symptoms of abdominal spasms and constipation could be indicative of a partial obstruction, which requires prompt medical attention.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain, bloating, and changes in bowel habits. However, the onset of these symptoms at the age of 75 would be unusual.
- Carcinoid Syndrome: This rare condition, often associated with neuroendocrine tumors, can cause abdominal pain, bloating, and changes in bowel habits due to the secretion of various hormones. The diagnosis is challenging and typically requires a high index of suspicion and specific diagnostic tests.