Differential Diagnosis
The patient presents with a complex history of pelvic pain, anemia, anxiety, and new concerns of abdominal pain and swelling. The following differential diagnosis is organized into categories:
- Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): The patient's symptoms of abdominal pain, bloating, and changes in bowel movements are consistent with IBS. The improvement in symptoms with antibiotics and the presence of anxiety also support this diagnosis.
- Other Likely Diagnoses
- Inflammatory Bowel Disease (IBD): The patient's history of abdominal pain, bloating, and changes in bowel movements, as well as the improvement with antibiotics, could also suggest IBD, such as Crohn's disease or ulcerative colitis.
- Endometriosis: The patient's history of pelvic pain and the presence of a feeling of fullness could be consistent with endometriosis, especially given the lack of significant pathology on imaging studies.
- Small Intestine Bacterial Overgrowth (SIBO): The patient's symptoms of bloating, abdominal pain, and improvement with antibiotics could suggest SIBO.
- Do Not Miss Diagnoses
- Ovarian Torsion: Although the patient has had multiple imaging studies showing no significant pathology, ovarian torsion is a rare but potentially life-threatening condition that must be considered, especially given the patient's history of pelvic pain.
- Appendicitis: The patient's symptoms of abdominal pain and bloating could be consistent with appendicitis, which is a medical emergency.
- Bowel Obstruction: The patient's history of gastric bypass surgery and symptoms of abdominal pain and bloating could suggest a bowel obstruction, which is a medical emergency.
- Rare Diagnoses
- Celiac Disease: The patient's symptoms of abdominal pain, bloating, and changes in bowel movements could be consistent with celiac disease, although this is less likely given the lack of other symptoms such as diarrhea or weight loss.
- Malabsorption: The patient's history of gastric bypass surgery and symptoms of abdominal pain and bloating could suggest malabsorption, although this is less likely given the lack of other symptoms such as diarrhea or weight loss.
- Chronic Intestinal Pseudo-Obstruction: The patient's symptoms of abdominal pain, bloating, and changes in bowel movements could be consistent with chronic intestinal pseudo-obstruction, although this is a rare condition.