Differential Diagnosis

The patient presents with a complex set of symptoms including abdominal cramping, nausea, vomiting, and alterations in bowel habits, alongside a history of gastrointestinal issues. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Irritable Bowel Syndrome (IBS): Given the patient's history of IBS, the current symptoms of abdominal cramping, nausea, vomiting, alternating constipation and diarrhea, and gassiness are consistent with an exacerbation of IBS. The relief of symptoms with a hot bath and the pattern of symptoms also support this diagnosis.
• Other Likely Diagnoses
  • Gastroesophageal Reflux Disease (GERD) Exacerbation: The patient's history of GERD, combined with symptoms of morning abdominal cramping, nausea, and vomiting, could indicate an exacerbation of GERD, especially if dietary or positional factors are contributing.
  • Functional Dyspepsia: This condition is characterized by persistent or recurrent upper abdominal pain or discomfort that is not exclusively relieved by defecation or associated with the onset of a change in stool frequency or form. The patient's symptoms of epigastric pain and nausea could fit this diagnosis.
  • Inflammatory Bowel Disease (IBD): Although the patient had a previous extensive workup that was within normal limits, the symptoms of abdominal cramping, diarrhea, and vomiting could suggest IBD, particularly if there has been a change in disease activity or if the previous workup missed the diagnosis.
• Do Not Miss Diagnoses
  • Gastrointestinal Obstruction: Although less likely given the patient's ability to vomit undigested food and the absence of absolute constipation, a partial obstruction could present with similar symptoms and would be a critical diagnosis not to miss.
  • Peptic Ulcer Disease: The patient's epigastric pain and history of GERD could suggest peptic ulcer disease, which would require urgent evaluation and treatment to prevent complications like perforation or bleeding.
  • Infectious Gastroenteritis: Given the patient's recent exposure to a viral illness through her husband, an infectious cause of her symptoms should be considered, especially if there are signs of dehydration or systemic infection.
• Rare Diagnoses
  • Gastric Cancer: Although rare, especially in the absence of alarm symptoms like significant weight loss or iron deficiency anemia, gastric cancer could present with nonspecific symptoms of abdominal discomfort, nausea, and vomiting.
  • Chronic Intestinal Pseudo-obstruction: This rare condition involves the impairment of the muscle contractions that move food, fluid, and air through the intestines, leading to symptoms that can mimic mechanical obstruction without any physical blockage.
  • Eosinophilic Gastroenteritis: A rare condition characterized by the presence of eosinophils in the gastrointestinal tract, leading to symptoms like abdominal pain, nausea, vomiting, and diarrhea, which could be considered if other diagnoses are ruled out and eosinophilia is present.