Differential Diagnosis
The patient presents with a three-day history of diarrhea and left upper quadrant abdominal pain, which could be attributed to various causes. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Recurrent H. pylori infection: The patient's past medical history of H. pylori infection, positive antibody finger-prick test, and symptoms of diarrhea and abdominal pain make this a likely diagnosis. However, the urea breath test (UBT) will confirm whether the infection is active.
- Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): The patient's symptoms of left upper quadrant abdominal pain and diarrhea could be related to GERD, especially given her history of cholecystectomy.
- Irritable bowel syndrome (IBS): The patient's diarrhea and abdominal pain, in the absence of other alarming symptoms like blood in stool or fever, could suggest IBS.
- Food poisoning or gastroenteritis: Although the patient denies recent travel or changes in diet, she does report biting her nails and kissing her dog, which could be potential sources of infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pancreatitis: The patient's left upper quadrant abdominal pain could be a sign of pancreatitis, which would require immediate medical attention.
- Splenic infarction or rupture: Given the patient's location of pain, a splenic infarction or rupture should be considered, especially if she has a history of splenomegaly or other underlying conditions.
- Gastric cancer: Although less likely, gastric cancer could present with similar symptoms, and the patient's past H. pylori infection increases her risk.
- Rare diagnoses
- Intestinal parasitism: The patient's symptoms of diarrhea and abdominal pain, combined with her habit of biting her nails and kissing her dog, could suggest an intestinal parasite infection, such as giardiasis.
- Malabsorption syndrome: The patient's diarrhea and abdominal pain could be related to a malabsorption syndrome, such as celiac disease or lactose intolerance, although these would be less likely given her age and lack of other symptoms.