Differential Diagnosis for 35-year-old Female with Lower Abdominal Pain and Burning with Urination
- Single most likely diagnosis:
- Urinary Tract Infection (UTI) or Pyelonephritis: The patient's symptoms of burning with urination, severe lower abdominal discomfort, and mid bilateral back pain, along with the urine dip results showing large blood and no nitrates or leukocytes, suggest a UTI or pyelonephritis. However, the absence of nitrates and leukocytes is unusual for a typical UTI, which might suggest a more complex infection or another diagnosis.
- Other Likely diagnoses:
- Kidney Stones: The severe lower abdominal discomfort and mid bilateral back pain could be indicative of kidney stones, especially with the presence of blood in the urine.
- Endometriosis: Given the patient's history of irregular menses and severe lower abdominal pain, endometriosis could be a contributing factor, although it doesn't directly explain the urinary symptoms.
- Interstitial Cystitis: This condition could explain the burning with urination and lower abdominal pain, especially if the patient's symptoms persist and other diagnoses are ruled out.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Ectopic Pregnancy: Although the urine pregnancy test is negative, it's crucial to consider ectopic pregnancy, especially given the patient's IUD and irregular menses. A negative pregnancy test does not entirely rule out ectopic pregnancy, especially if the test was done too early.
- Ovarian Torsion: This is a surgical emergency that can present with severe lower abdominal pain and is more likely in someone with an IUD, although it's less common.
- Appendicitis: While the patient's symptoms don't perfectly align with classic appendicitis, it's a condition that requires prompt surgical intervention if suspected.
- Rare diagnoses:
- Tuberculosis of the Urinary Tract: This could explain some of the patient's symptoms, including hematuria and abdominal pain, although it's less common.
- Malignancy (e.g., ovarian or renal cancer): These conditions are rare in young women but could present with some of the symptoms described, such as abdominal pain and hematuria.