Differential Diagnosis for a 57-year-old Female with Abdominal Pain, Diarrhea, and Low Hemoglobin
Single most likely diagnosis:
- Colorectal cancer: This is a leading consideration due to the patient's age, symptoms of abdominal pain and diarrhea, and significantly low hemoglobin level without reported bleeding. The absence of visible blood in the stool (occult bleeding) can lead to iron deficiency anemia, which is consistent with the low hemoglobin level.
Other Likely diagnoses:
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic diarrhea, abdominal pain, and anemia due to chronic blood loss or malabsorption.
- Gastrointestinal infections: Certain bacterial, viral, or parasitic infections can lead to similar symptoms, although the severe anemia might be less common without visible bleeding.
- Celiac disease: An autoimmune reaction to gluten can cause malabsorption, leading to diarrhea and anemia, among other symptoms.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Upper GI malignancy with occult bleeding: Although the patient denies bleeding, an upper GI source (like stomach or small intestine cancer) could be causing slow, occult bleeding leading to severe anemia.
- Ischemic bowel disease: Reduced blood flow to the intestines can cause abdominal pain and diarrhea, with anemia resulting from chronic or occult bleeding.
- Diverticulitis or diverticular disease: While more commonly associated with visible bleeding, diverticulitis (inflammation of a diverticulum) could potentially cause occult bleeding and anemia.
Rare diagnoses:
- Intestinal lymphoma: A type of cancer that starts in the immune cells of the intestine, which can cause a range of symptoms including diarrhea, abdominal pain, and anemia.
- Whipple's disease: A rare, systemic bacterial infection that can cause malabsorption, leading to diarrhea, weight loss, and anemia, among other symptoms.
- Amyloidosis: A condition characterized by the deposition of abnormal proteins (amyloid) in various tissues, which can affect the GI tract and cause symptoms like diarrhea and anemia.