Differential Diagnosis for Lower Abdominal Pain
Single Most Likely Diagnosis
- Constipation or Irritable Bowel Syndrome (IBS): Given that the pain has been improving, a self-limiting or functional gastrointestinal disorder is plausible. These conditions are common and can cause lower abdominal pain that may wax and wane.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): Although the pain is improving, a UTI could still be a consideration, especially if the patient is female. UTIs can cause lower abdominal pain and may resolve with or without treatment.
- Ovarian Cyst: In females, an ovarian cyst could cause lower abdominal pain. The fact that the pain is improving might suggest a cyst that has ruptured or is resolving on its own.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain and may have periods of improvement. However, they typically require medical management to control symptoms.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although less likely if the patient is male or if pregnancy has been ruled out, an ectopic pregnancy is a medical emergency that must be considered in any female patient of childbearing age presenting with lower abdominal pain.
- Appendicitis: Even though the pain is improving, appendicitis can present atypically, especially in retrocecal appendicitis. It's crucial to rule out appendicitis due to the risk of rupture and peritonitis.
- Diverticulitis: In older adults, diverticulitis can cause lower abdominal pain and may improve with antibiotics. However, complications like abscesses or perforation can be life-threatening.
- Ovarian Torsion: Another gynecologic emergency, ovarian torsion can cause severe lower abdominal pain and requires immediate surgical intervention.
Rare Diagnoses
- Endometriosis: While not extremely rare, endometriosis can cause chronic lower abdominal pain, especially in females. It's less likely to be considered if the pain is improving, but it should be on the differential for chronic or recurrent pain.
- Intussusception: More common in children but can occur in adults, intussusception is a condition where a part of the intestine telescopes into another, causing bowel obstruction and potentially severe pain.
- Lymphoma: Abdominal lymphoma can cause pain due to lymph node enlargement or bowel obstruction. It's a rare consideration for lower abdominal pain but should be kept in mind, especially with systemic symptoms like weight loss or fever.