Differential Diagnosis
- The patient's presentation of lower abdominal cramping, dysmenorrhea, and GI symptoms, in conjunction with her existing conditions and medications, leads to a multifaceted differential diagnosis.
Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): This diagnosis is likely due to the patient's long history of intermittent GI symptoms, which are common in IBS. The abdominal cramping and presence of menses also support this diagnosis, as IBS symptoms can be exacerbated by menstrual cycles.
Other Likely Diagnoses
- Pelvic Inflammatory Disease (PID): Although the patient is on oral contraceors, which reduce the risk of PID, the presence of lower abdominal cramping and a history of dysmenorrhea make PID a possible diagnosis, especially if there has been a change in sexual activity or if the patient has not been adherent to her contraceptive regimen.
- Inflammatory Bowel Disease (IBD): The patient's history of GI symptoms and the presence of abdominal cramping could suggest IBD, such as Crohn's disease or ulcerative colitis. However, the fact that her symptoms are intermittent and she has a history of dysmenorrhea might make this less likely.
- Adnexal Cyst or Ovarian Cyst: These are common in women of reproductive age and can cause lower abdominal pain, especially if they rupture or torsion occurs. The patient's current menses and history of dysmenorrhea are relevant.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although the patient is on oral contraceors, which significantly reduces the risk, it is crucial to rule out ectopic pregnancy due to its potentially life-threatening nature. A pregnancy test should be performed.
- Appendicitis: This is a medical emergency that requires prompt diagnosis and treatment. Although the patient's pain is described as cramping and associated with menses, appendicitis can present with variable symptoms and should always be considered in the differential for lower abdominal pain.
- Wilson's Disease: Given the slightly elevated copper and ceruloplasmin levels, Wilson's disease should be considered, especially since it can cause GI symptoms, psychiatric symptoms (like depression), and is more common in younger individuals.
Rare Diagnoses
- Endometriosis: While this is a common cause of dysmenorrhea and pelvic pain, the fact that the patient is already experiencing relief from dysmenorrhea with oral contraceors makes this less likely as the primary cause of her current symptoms. However, it could still contribute to her symptomatology.
- Celiac Disease: This autoimmune disorder can cause GI symptoms and has been associated with various extra-intestinal manifestations, including psychiatric symptoms. However, without more specific symptoms like diarrhea, weight loss, or malabsorption, this is less likely.