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.
- 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 in the differential diagnosis.
- Appendicitis: The patient's symptoms of abdominal pain and bloating could be consistent with appendicitis, especially if the pain is localized to the lower right quadrant.
- Bowel Obstruction: The patient's history of gastric bypass surgery and symptoms of abdominal pain and bloating could suggest a bowel obstruction.
- Rare Diagnoses
- Malabsorption: The patient's history of gastric bypass surgery and symptoms of bloating and abdominal pain could suggest malabsorption.
- Celiac Disease: The patient's symptoms of abdominal pain and bloating could be consistent with celiac disease, although this would be less likely given the lack of other symptoms such as diarrhea or weight loss.
- Intestinal Ischemia: The patient's symptoms of abdominal pain and bloating could be consistent with intestinal ischemia, although this would be less likely given the patient's age and lack of other risk factors.