Differential Diagnosis

The patient presents with abdominal pain, back pain, and increased urinary frequency. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Irritable Bowel Syndrome (IBS) exacerbation: The patient has a history of IBS, and the symptoms of abdominal pain, bloating, and nausea are consistent with an exacerbation of IBS. The normal appetite and bowel movements also support this diagnosis.
• Other Likely diagnoses
  • Interstitial Cystitis flare: The patient has a history of interstitial cystitis, and the symptoms of increased urinary frequency and abdominal pain could be consistent with a flare of this condition.
  • Ovarian cyst or remnant: Although the ultrasound did not show any significant ovarian cysts, it is possible that a small cyst or remnant could be causing the patient's symptoms.
  • Musculoskeletal back pain: The patient's lower back pain radiating to the hips could be related to a musculoskeletal issue, such as strain or overuse.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Ectopic pregnancy: Although the patient has had a tubal ligation and ablation, it is still possible for an ectopic pregnancy to occur, and this diagnosis should not be missed.
  • Ovarian torsion: This is a rare but potentially life-threatening condition that requires prompt diagnosis and treatment.
  • Appendicitis: Although the patient's symptoms are not typical for appendicitis, this diagnosis should still be considered, especially if the patient's symptoms worsen or change.
• Rare diagnoses
  • Endometriosis: The patient's symptoms of abdominal pain and back pain could be consistent with endometriosis, although this diagnosis is less likely given the patient's history and normal ultrasound.
  • Inflammatory bowel disease: The patient's symptoms of abdominal pain and bloating could be consistent with inflammatory bowel disease, although this diagnosis is less likely given the patient's normal colonoscopy at age 18.