Differential Diagnosis for a 32 YOF with Reported Worms in Stool
Single Most Likely Diagnosis
- Intestinal Obstruction: Given the patient's symptoms of persistent nausea, vomiting (with bile appearance), and a 5-day history of no bowel movements, intestinal obstruction is a highly plausible diagnosis. The presence of worms in the stool could be a secondary finding or a contributing factor, but the primary concern is the obstruction itself, which could be caused by various factors including adhesions, hernias, or volvulus.
Other Likely Diagnoses
- Gastrointestinal Infection: The patient's symptoms of nausea, vomiting, and altered bowel habits could suggest a gastrointestinal infection. The presence of worms in the stool might indicate a parasitic infection, such as ascariasis or hookworm infection, which is plausible given her occupation as a veterinarian assistant and potential exposure to parasites.
- Inflammatory Bowel Disease (IBD): Although less likely given the acute presentation, IBD (e.g., Crohn's disease or ulcerative colitis) could explain the patient's symptoms, including altered bowel habits and nausea. The presence of worms might be incidental or related to immunosuppression in the context of IBD treatment.
- Food Allergy or Intolerance: Given the patient's history of wheat allergy, it's possible that she has experienced an adverse reaction to something in her diet, leading to gastrointestinal symptoms. However, the presence of worms in the stool and the severity of her symptoms (e.g., vomiting bile) make this less likely as a primary diagnosis.
Do Not Miss Diagnoses
- Appendicitis: Although the patient's symptoms do not classically suggest appendicitis (e.g., no mention of abdominal pain migrating to the right lower quadrant), it is a diagnosis that cannot be missed due to its potential for severe complications if not promptly treated. The presence of nausea, vomiting, and altered bowel habits could be part of the appendicitis presentation.
- Mesenteric Ischemia: This is a life-threatening condition that requires immediate diagnosis and treatment. The patient's symptoms of persistent nausea, vomiting, and abdominal issues could be indicative of mesenteric ischemia, especially if there's a history of vascular disease or risk factors for thromboembolism.
- Intussusception: This condition, where a part of the intestine telescopes into another, can cause intestinal obstruction and is more common in children but can occur in adults. It's a diagnosis that should not be missed due to its potential for severe complications.
Rare Diagnoses
- Strongyloidiasis: This parasitic infection can cause gastrointestinal symptoms and is more common in immunocompromised individuals or those with a history of exposure to contaminated soil. Given the patient's occupation, this could be a consideration, although it is less likely.
- Whipple's Disease: A rare, systemic bacterial infection that can cause malabsorption, weight loss, and gastrointestinal symptoms. It's an unlikely diagnosis but should be considered in the differential for chronic, unexplained gastrointestinal symptoms.
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause a variety of symptoms including nausea, vomiting, and abdominal pain. This diagnosis might be considered if the patient has a history of atopic diseases (like her wheat allergy) and the presence of eosinophilia in her blood work.