Differential Diagnosis for a 33-year-old Female with LDL 138, Ferritin 156, Normal LFTs, and Chronic Bloating

• Single Most Likely Diagnosis
  • Irritable Bowel Syndrome (IBS): Given the chronic bloating and absence of alarming symptoms such as weight loss, blood in stool, or fever, IBS is a common and likely diagnosis. The normal LFTs and mildly elevated ferritin without other signs of iron overload syndrome also support this, as they do not strongly indicate a liver or hematologic disorder.
• Other Likely Diagnoses
  • Dyspepsia: Could be a cause of bloating, especially if related to eating or digestive issues. The normal LFTs and lack of other symptoms make this less likely than IBS but still plausible.
  • Small Intestine Bacterial Overgrowth (SIBO): Can cause bloating and is often considered in the differential for IBS. The elevated ferritin could be incidental or related to inflammation.
  • Polycystic Ovary Syndrome (PCOS): Although not directly related to bloating, PCOS can cause metabolic disturbances, including changes in lipid profiles (like the slightly elevated LDL) and insulin resistance, which might indirectly contribute to bloating. The elevated ferritin could be related to metabolic syndrome components.
• Do Not Miss Diagnoses
  • Celiac Disease: An autoimmune disorder that can cause bloating, malabsorption, and elevated liver enzymes (though LFTs are normal in this case, celiac disease can have variable presentations). It's crucial to rule out due to its potential for long-term complications if untreated.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic bloating among other symptoms. Although the normal LFTs and lack of other symptoms (like diarrhea or blood in stool) make this less likely, missing IBD could lead to significant morbidity.
  • Hemochromatosis: A genetic disorder leading to iron overload. Although the ferritin level is only mildly elevated and not diagnostic on its own, it's essential to consider given the potential for severe complications if left untreated.
• Rare Diagnoses
  • Gastroparesis: A condition where the stomach takes too long to empty its contents, which can cause bloating. It's less common and usually associated with diabetes or other specific conditions.
  • Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause a variety of symptoms including bloating.
  • Mitochondrial Disorders: Rare genetic disorders affecting the mitochondria, which can have a wide range of symptoms including gastrointestinal issues like bloating. These would be considered very low on the differential without other supporting symptoms or family history.