Differential Diagnosis for 66 yo Female Patient with Right Lower Quadrant Abdominal Pain
- Single Most Likely Diagnosis
- Cholecystitis or cholelithiasis: The patient's symptoms of right lower quadrant abdominal pain that improves with limitation of spicy and acidic foods suggest a possible gallbladder pathology. The pain profile and dietary triggers are classic for gallstones or inflammation of the gallbladder.
- Other Likely Diagnoses
- Peptic ulcer disease: Given the improvement with avoidance of spicy and acidic foods, peptic ulcer disease (PUD) is a plausible diagnosis. The location of pain can sometimes be atypical, and the relation to food intake is a common feature.
- Irritable bowel syndrome (IBS): Although IBS can present with a variety of symptoms, the chronic nature of the pain and its relation to food intake could fit this diagnosis, especially if other pathologies are ruled out.
- Diverticulitis: While the patient had a normal colonoscopy 10 years ago, the possibility of new diverticula formation or diverticulitis, especially if the pain is more left lower quadrant but can sometimes be felt in the right, should be considered.
- Do Not Miss Diagnoses
- Appendicitis: Although the patient's age and the chronic nature of the pain make appendicitis less likely, it is a diagnosis that cannot be missed due to its potential for severe complications if not treated promptly.
- Ovarian cancer: Despite the patient's history of total hysterectomy, the possibility of ovarian cancer (if the ovaries were not removed) or other gynecologic malignancies should be considered, especially in postmenopausal women with persistent abdominal symptoms.
- Intestinal obstruction or volvulus: These conditions can present with abdominal pain and require immediate medical attention to prevent serious complications.
- Rare Diagnoses
- Crohn's disease or ulcerative colitis: Inflammatory bowel diseases can present at any age and with a variety of symptoms, including right lower quadrant pain, but would be less common in this age group without prior symptoms.
- Carcinoid tumor: A rare tumor that could cause abdominal pain, among other symptoms, and is often found in the small intestine.
- Mesenteric panniculitis: A rare condition characterized by inflammation of the mesenteric fat, which can cause chronic abdominal pain.