Differential Diagnosis

The patient's symptoms of stomach sensitivity, gassiness, and urges during periods of nervousness, followed by the onset of diarrhea after consuming junk food and alcohol, suggest a gastrointestinal disorder. Here's a differential diagnosis based on the provided information:

• Single most likely diagnosis
  • Post-Infectious Irritable Bowel Syndrome (PI-IBS): The patient's symptoms started after a bout of diarrhea, which could have been triggered by food poisoning or a gastrointestinal infection from consuming alcohol, juices, and hash brownies. This event could have led to the development of PI-IBS, characterized by persistent bowel symptoms after an infectious gastroenteritis.
• Other Likely diagnoses
  • Primary Irritable Bowel Syndrome (IBS): The patient's initial symptoms of mild sensitivity, gassiness, and urges during exams could be indicative of IBS, which is a functional gastrointestinal disorder. However, the onset of diarrhea after consuming junk food and alcohol makes PI-IBS a more likely diagnosis.
  • Functional Dyspepsia: The patient's symptoms of stomach sensitivity and gassiness could also be related to functional dyspepsia, which is characterized by recurring symptoms of upper abdominal discomfort or pain.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Inflammatory Bowel Disease (IBD): Although less likely, IBD (including Crohn's disease and ulcerative colitis) could present with similar symptoms, including diarrhea and abdominal pain. Missing this diagnosis could lead to severe complications, making it essential to rule out IBD through further testing.
  • Gastrointestinal Cancer: Although rare in young individuals, gastrointestinal cancer could present with nonspecific symptoms, including abdominal pain, changes in bowel habits, and weight loss. It is crucial to consider this possibility, especially if the patient's symptoms persist or worsen over time.
• Rare diagnoses
  • Celiac Disease: An autoimmune disorder that causes the immune system to react to gluten, leading to small intestine damage and symptoms like diarrhea, abdominal pain, and weight loss.
  • Small Intestine Bacterial Overgrowth (SIBO): A condition characterized by an excessive growth of bacteria in the small intestine, leading to symptoms like bloating, gas, and diarrhea.