Differential Diagnosis for 61 YOF with Lower ABD Pain
Single Most Likely Diagnosis
- Cholecystitis: Given the patient's recent CT scan showing gallstones and the presentation of progressive lower abdominal pain, nausea, and tenderness to palpation in the lower abdominal quadrants, cholecystitis is a highly plausible diagnosis. The presence of gallstones is a significant risk factor for developing cholecystitis.
Other Likely Diagnoses
- Bowel Obstruction: The patient's history of abdominal surgery (hysterectomy) and current chemotherapy treatment increases the risk of bowel obstruction, which could present with abdominal pain, nausea, and tenderness.
- Diverticulitis: The patient's age and symptoms of lower abdominal pain and tenderness could suggest diverticulitis, especially if there's a history of diverticular disease.
- Chemotherapy-induced side effects: The patient's ongoing chemotherapy could be causing or exacerbating her abdominal symptoms, including pain and nausea.
Do Not Miss Diagnoses
- Ovarian Cancer Recurrence: Although the patient had a hysterectomy, ovarian cancer can recur and present with abdominal pain and other non-specific symptoms. Given her history of adenocarcinoma of the uterus, it's crucial to consider the possibility of recurrence.
- Perforated Viscus: A perforation in the gastrointestinal tract can lead to severe abdominal pain, tenderness, and potentially life-threatening complications if not promptly addressed.
- Mesenteric Ischemia: This condition, involving insufficient blood flow to the intestines, can present with severe abdominal pain out of proportion to physical examination findings and is a medical emergency.
Rare Diagnoses
- Neutropenic Colitis (Typhlitis): Given the patient's current chemotherapy treatment, which can cause neutropenia, there's a rare but possible risk of developing neutropenic colitis, characterized by inflammation of the cecum.
- Abdominal Lymphoma: Although less common, lymphoma involving the abdomen could present with non-specific symptoms such as abdominal pain and nausea, especially in the context of a patient with a history of cancer.