Differential Diagnosis for a 42 YOM with Intermittent Episodes of Liquid Red Bloody Stool and RUQ ABD Pain
Single Most Likely Diagnosis
- Inflammatory Bowel Disease (IBD), specifically Ulcerative Colitis: Given the patient's history of salmonella, which can trigger IBD, and the symptoms of intermittent liquid red bloody stool with clots, this diagnosis is highly plausible. The abdominal pain, particularly in the right upper quadrant (RUQ), could be related to the involvement of the terminal ileum in ulcerative colitis or the development of a complication such as a stricture.
Other Likely Diagnoses
- Crohn's Disease: Another form of IBD that can present with similar symptoms, including bloody stools and abdominal pain. The history of salmonella could be a triggering factor.
- Intestinal Ischemia: Although less common, the patient's symptoms could suggest intestinal ischemia, especially if the abdominal pain is out of proportion to the physical findings. This condition requires prompt diagnosis and treatment.
- Diverticulitis: While typically presenting with left lower quadrant pain, diverticulitis can occasionally cause right-sided symptoms, especially if the diverticula are located in the right colon. Bloody stools can also occur.
Do Not Miss Diagnoses
- Colon Cancer: Although less likely in a 42-year-old, colon cancer can present with bloody stools and abdominal pain. Given the potential for significant morbidity and mortality, it's crucial not to miss this diagnosis.
- Infectious Colitis: Re-infection or a different infectious agent could cause the patient's symptoms. Certain infections, like Clostridioides difficile, can be life-threatening and require specific treatment.
- Mesenteric Thrombosis: A rare but potentially fatal condition that could present with abdominal pain and bloody stools due to intestinal infarction.
Rare Diagnoses
- Ehlers-Danlos Syndrome with Intestinal Perforation: A rare genetic disorder that can lead to intestinal perforation and potentially present with the described symptoms.
- Henoch-Schönlein Purpura (HSP): A systemic vasculitis that can cause gastrointestinal symptoms, including bloody stools and abdominal pain, although it's more commonly associated with skin, joint, and kidney involvement.
- Intussusception: A condition where a part of the intestine telescopes into another, which can cause intestinal obstruction and ischemia, presenting with abdominal pain and bloody stools. It's rare in adults but can be associated with a lead point such as a tumor.