Differential Diagnosis

The patient presents with reflux, right upper quadrant pain, and a history of sessile colon polyps, ovarian cysts, and ankylosing spondylitis. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Gastroesophageal reflux disease (GERD) with possible gallbladder disease: The patient's symptoms of reflux and right upper quadrant pain, without rebound or guarding, could suggest GERD with a potential gallbladder issue, such as cholecystitis or cholelithiasis, given the location of the pain.
• Other Likely Diagnoses
  • Peptic ulcer disease: The burning sensation in the right costovertebral angle (CVA) could be referred pain from a peptic ulcer.
  • Inflammatory bowel disease (IBD) flare: Given the patient's history of ankylosing spondylitis and sessile colon polyps, an IBD flare (e.g., Crohn's disease or ulcerative colitis) could explain the abdominal pain and potentially the reflux symptoms.
  • Ovarian cyst complication: Although less likely given the negative urine analysis, a complication from an ovarian cyst (e.g., torsion, rupture) could cause abdominal pain and should be considered, especially with the patient's history of ovarian cysts.
• Do Not Miss Diagnoses
  • Appendicitis: Although the pain is not typically in the right lower quadrant, appendicitis can present atypically, especially in patients with a history of abdominal surgery or other anatomical variations. It's crucial to consider this diagnosis due to its potential for severe consequences if missed.
  • Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant pain and could be a serious condition if not addressed promptly.
  • Pancreatitis: Abdominal pain and reflux could be symptoms of pancreatitis, which requires immediate medical attention.
• Rare Diagnoses
  • Intestinal obstruction: Although less likely without a history of surgery or other risk factors, an intestinal obstruction could cause abdominal pain and reflux symptoms.
  • Hepatic or renal infarction: These conditions are rare but could present with acute abdominal pain and would require urgent diagnosis and treatment.

Each of these diagnoses should be considered and evaluated based on further history, physical examination, and diagnostic tests to determine the most appropriate diagnosis and treatment plan for the patient.