Differential Diagnosis
- Single most likely diagnosis:
- Generalized anxiety disorder with somatic symptoms: The patient's history of health anxiety, IBS anxiety, and multiple physical complaints without significant changes or evidence of infection suggest that her symptoms may be exacerbated or primarily caused by her anxiety.
- Other Likely diagnoses:
- Benign lymphadenopathy: The presence of palpable lymph nodes for 7 months without change or signs of infection could indicate a benign condition.
- Irritable Bowel Syndrome (IBS): The patient's symptoms of fullness under the left ribs and altered bowel habits (fluffy, flaky, and runny stool) are consistent with IBS, especially given her history of IBS anxiety.
- Dermatological conditions (e.g., benign nevus or seborrheic keratosis): The mole in the belly button, which has been present for 13 years and was deemed benign by a dermatologist, may have undergone benign changes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Lymphoma: Although less likely given the stable nature of the lymph nodes, lymphoma is a critical diagnosis to consider due to its potential severity.
- Metastatic melanoma: Despite the low likelihood, given the mole's long-standing presence and previous benign assessment, any change in a mole warrants consideration of melanoma, especially if it has grown or developed darker areas.
- Intra-abdominal malignancy (e.g., lymphoma, gastrointestinal cancer): The patient's symptoms of fullness under the left ribs could, in rare cases, indicate an intra-abdominal malignancy.
- Rare diagnoses:
- Sarcoidosis: A systemic granulomatous disease that can cause lymphadenopathy and gastrointestinal symptoms, although it would be an uncommon explanation for this patient's specific constellation of symptoms.
- Other rare lymphoproliferative disorders: Conditions like Castleman disease could present with lymphadenopathy and systemic symptoms, but these are exceedingly rare and would require further investigation to diagnose.