Differential Diagnosis for 39-year-old Female with RUQ Dull Pain and Constipation

• Single most likely diagnosis:
  • Irritable Bowel Syndrome (IBS): The patient's symptoms of RUQ dull pain, constipation, and relief with fiber supplements are consistent with IBS. The chronic nature of her symptoms and the need for daily fiber intake to maintain regular bowel movements also support this diagnosis.
• Other Likely diagnoses:
  • Gastroesophageal Reflux Disease (GERD): Although the patient's primary complaint is RUQ pain and constipation, GERD can sometimes present with atypical symptoms, including abdominal pain and changes in bowel habits.
  • Functional Constipation: Given the patient's history of constipation and reliance on fiber supplements, functional constipation is a possible diagnosis. However, the presence of RUQ pain makes IBS a more likely explanation.
  • Gallbladder Disease (e.g., cholecystitis, cholelithiasis): The patient's RUQ pain could be indicative of gallbladder disease, although the absence of other symptoms like fever, jaundice, or severe pain makes this less likely.
• Do Not Miss diagnoses:
  • Appendicitis: Although the patient's pain is in the RUQ and not the typical RLQ location, appendicitis can occasionally present with atypical symptoms, especially in women. It's essential to consider this diagnosis due to its potential for severe consequences if missed.
  • Hepatic or Renal Pathology (e.g., hepatitis, pyelonephritis): Infections or other pathologies affecting the liver or kidneys could cause RUQ pain and should be considered, especially if the patient has other symptoms like fever, jaundice, or flank pain.
  • Ovarian Torsion or Other Gynecologic Emergencies: These conditions can cause severe abdominal pain and should be considered in any female patient with acute abdominal pain, although the patient's chronic symptoms make this less likely.
• Rare diagnoses:
  • Inflammatory Bowel Disease (e.g., Crohn's disease, ulcerative colitis): While IBD can cause chronic abdominal pain and changes in bowel habits, it is less likely than IBS given the patient's symptoms and lack of other systemic symptoms like weight loss or bloody stools.
  • Celiac Disease: This autoimmune disorder can cause abdominal pain, constipation, and other gastrointestinal symptoms, but it is relatively rare and would require further testing to diagnose.
  • Abdominal Wall Pain or Other Musculoskeletal Causes: The patient's RUQ pain could be referred from the abdominal wall or other musculoskeletal structures, although this would be an uncommon cause of her symptoms.