Differential Diagnosis
- Single most likely diagnosis
- Irritable Bowel Syndrome (IBS): This is the most likely diagnosis given the patient's symptoms of intermittent diarrhea and constipation, severe cramping abdominal pain, and the absence of fever, weight loss, or blood in the stool. The pattern of symptoms over 2 years without significant weight loss or other systemic symptoms also supports this diagnosis.
- Other Likely diagnoses
- Bacterial gastroenteritis: Although the patient returned from a trip to Mexico 3 months ago, the chronic nature of her symptoms (2-year history) makes this less likely as the primary cause. However, it could be considered if the symptoms initially started after the trip.
- Laxative abuse: This could be a consideration given the symptoms of intermittent diarrhea, but there's no direct evidence provided in the scenario to strongly support this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Crohn's disease: Although less likely given the absence of systemic symptoms like fever and weight loss, Crohn's disease can present with similar gastrointestinal symptoms and must be considered to avoid missing a potentially serious condition.
- Intermittent small-bowel obstruction: This condition could cause severe abdominal pain and alterations in bowel habits. Given the patient's history of abdominal surgery (appendectomy and cesarean delivery), adhesions could be a cause of intermittent obstruction, making this a critical diagnosis not to miss.
- Rare diagnoses
- Other infectious causes: Such as giardiasis or other parasitic infections, which could be considered given the travel history, but are less likely given the chronic nature of symptoms and the absence of other supportive evidence.
- Malabsorptive disorders: Conditions like celiac disease could present with similar gastrointestinal symptoms but would typically include other systemic symptoms or evidence of malabsorption, which are not mentioned in the scenario.