Differential Diagnosis
- Single most likely diagnosis
- Irritable Bowel Syndrome (IBS): The patient's complaint of intermittent fullness under the left ribs, worsened by sitting, could be related to gastrointestinal issues. IBS is a common condition that can cause abdominal discomfort, bloating, and changes in bowel habits. The presence of severe health anxiety may also contribute to the exacerbation of IBS symptoms.
- Other Likely diagnoses
- Gastroesophageal Reflux Disease (GERD): GERD can cause intermittent abdominal fullness and discomfort, especially after eating or when lying down. The symptoms may worsen when sitting, and the patient's anxiety could be contributing to the perception of symptoms.
- Splenomegaly (enlarged spleen): The fullness under the left ribs could be related to an enlarged spleen, which can be caused by various conditions such as infections, liver disease, or blood disorders. The palpable left elbow lymph nodes may indicate a systemic infection or inflammation.
- Lymphadenopathy (enlarged lymph nodes): The presence of palpable lymph nodes in the left elbow could be related to a localized infection, autoimmune disorder, or lymphoma. Further evaluation is necessary to determine the cause of lymphadenopathy.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lymphoma: Although less likely, lymphoma is a potentially life-threatening condition that requires prompt diagnosis and treatment. The presence of palpable lymph nodes and systemic symptoms such as fatigue warrants further investigation.
- Sickle Cell Disease: This genetic disorder can cause splenomegaly, abdominal pain, and lymphadenopathy. Although less common, it is essential to consider sickle cell disease in the differential diagnosis, especially if the patient has a family history or other risk factors.
- Gastric Cancer: Although rare in a 31-year-old, gastric cancer can cause abdominal fullness, weight loss, and lymphadenopathy. It is crucial to rule out this possibility, especially if the patient has a family history or other risk factors.
- Rare diagnoses
- Splenic Infarction: A rare condition that can cause abdominal pain and fullness, splenic infarction is usually associated with underlying conditions such as sickle cell disease or blood clots.
- Abdominal Lymphangioma: A rare benign tumor that can cause abdominal fullness and lymphadenopathy, abdominal lymphangioma is usually diagnosed incidentally during imaging studies.