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Differential Diagnosis for Alternating Diarrhea and Constipation in a 79y Female

Single Most Likely Diagnosis

  • Irritable Bowel Syndrome (IBS): This condition is characterized by a combination of abdominal pain, bloating, and alteration in bowel habits, which can include alternating diarrhea and constipation. The absence of fever and the intermittent nature of the abdominal pain support this diagnosis.

Other Likely Diagnoses

  • Diverticulitis: Although diverticulitis often presents with more severe abdominal pain and possibly fever, mild cases can occur, especially in the elderly. The intermittent abdominal pain could be consistent with this diagnosis.
  • Gastroesophageal Reflux Disease (GERD) and/or Functional Dyspepsia: These conditions can sometimes present with abdominal pain and alterations in bowel habits due to the overlap of symptoms with IBS or due to the effects of gastroesophageal reflux on bowel function.
  • Hypothyroidism: This condition can cause constipation but may also lead to changes in bowel habits, including diarrhea in some cases, due to its effects on the gastrointestinal system.

Do Not Miss Diagnoses

  • Colorectal Cancer: Although less likely, colorectal cancer can present with changes in bowel habits, including alternating diarrhea and constipation, especially in the elderly. It is crucial to rule out this diagnosis due to its severe implications.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can present with diarrhea, abdominal pain, and changes in bowel habits. While they often have more severe symptoms, mild cases can occur, and the diagnosis should not be missed.
  • Intestinal Obstruction: Partial obstruction can cause alternating diarrhea and constipation, along with abdominal pain. This is a medical emergency and must be considered, especially in the elderly.

Rare Diagnoses

  • Neuroendocrine Tumors: Certain tumors, like carcinoids, can produce substances that affect bowel habits, leading to diarrhea or constipation.
  • Amyloidosis: This condition can affect the gastrointestinal system, leading to changes in bowel habits among other symptoms.
  • Scleroderma: This autoimmune disease can affect the gastrointestinal tract, causing changes in bowel habits, including alternating diarrhea and constipation, due to esophageal dysmotility and other gastrointestinal manifestations.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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