Differential Diagnosis for Severe Health Anxiety and Associated Symptoms
Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): Given the fullness under the left ribs that worsens with sitting, this could be indicative of gastrointestinal issues. IBS is a common condition that can cause abdominal discomfort, bloating, and changes in bowel habits, which might be exacerbated by anxiety. The palpable lymph nodes could be reactive, and fatigue is a common symptom in both IBS and anxiety disorders.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): The symptom of fullness under the left ribs, especially when sitting, could be related to GERD, where stomach acid flows back into the esophagus, causing discomfort.
- Anxiety Disorder: While mentioned as a given, it's essential to consider that severe health anxiety itself can exacerbate or mimic physical symptoms, including fatigue and potentially contributing to the perception of other symptoms.
- Hypochondriasis: Now more commonly referred to under the umbrella of Illness Anxiety Disorder, this condition involves excessive worry about having a serious illness despite medical reassurance, which could explain the severe health anxiety.
Do Not Miss Diagnoses
- Lymphoma: Although less likely, the presence of palpable lymph nodes, particularly if they are persistent or growing, necessitates consideration of lymphoma. Early detection is crucial for effective treatment.
- Gastric or Pancreatic Cancer: These cancers can present with vague abdominal symptoms, including fullness or discomfort under the ribs, and fatigue. Early diagnosis significantly improves prognosis.
- Splenomegaly: An enlarged spleen could cause fullness under the left ribs and could be due to various causes, including infections, liver diseases, or blood disorders.
Rare Diagnoses
- Splenosis: If there's a history of trauma, splenosis (ectopic splenic tissue) could cause abdominal symptoms and might be considered if other diagnoses are ruled out.
- Castleman Disease: A rare disorder that involves an overgrowth of cells in the body's lymph nodes, which could explain the palpable lymph nodes and systemic symptoms like fatigue.
- Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues, which could potentially explain a variety of symptoms including gastrointestinal issues and fatigue, though it's a stretch without other specific signs.