Differential Diagnosis

The patient's presentation is complex, involving gastrointestinal, cardiovascular, and psychological symptoms. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Congestive Heart Failure (CHF): The patient's symptoms of shortness of breath, leg swelling, lethargy, and decreased exercise tolerance, along with the physical examination findings of generalized swelling, prominent abdominal veins, and striae, are suggestive of CHF. The recent weight gain and history of depression could also be contributing factors.
• Other Likely diagnoses
  • Liver Disease (e.g., Cirrhosis): Although the patient is not jaundiced and has no other stigmata of chronic liver disease, the presence of shifting dullness and prominent abdominal veins could indicate liver dysfunction. The recent history of abdominal discomfort and haematuria may also be related to liver disease.
  • Renal Vein Thrombosis: The patient's initial presentation with hematuria, polyuria, and abdominal discomfort, followed by the development of leg swelling and shortness of breath, could be indicative of renal vein thrombosis, particularly in the context of a possible hypercoagulable state (e.g., due to oral contraceptive use).
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pulmonary Embolism (PE): Although the patient's symptoms are more suggestive of CHF or liver disease, a PE could present with similar symptoms, including shortness of breath and leg swelling. Given the potential for oral contraceptive-related hypercoagulability, PE must be considered.
  • Budd-Chiari Syndrome: This rare condition, characterized by hepatic vein thrombosis, could present with similar symptoms, including abdominal discomfort, leg swelling, and shortness of breath. It is essential to consider this diagnosis due to its potential for severe consequences if left untreated.
• Rare diagnoses
  • Constrictive Pericarditis: This condition, characterized by a thickened and fibrotic pericardium, could present with similar symptoms, including shortness of breath, leg swelling, and decreased exercise tolerance. However, it is a rare condition and would require further evaluation to confirm.
  • Lymphatic Obstruction: A blockage of the lymphatic system, potentially due to a malignancy or other rare condition, could present with similar symptoms, including leg swelling and shortness of breath. However, this diagnosis is less likely and would require further evaluation to confirm.