Differential Diagnosis for Pressure and Fullness under Left Ribs
Given the symptoms of pressure and fullness under the left ribs that worsen when sitting down or laying on the right side, the following differential diagnoses are considered:
Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): This condition is characterized by recurrent abdominal pain associated with a change in bowel habits, which could explain the intermittent nature of the symptoms. The worsening of symptoms when sitting or laying on the right side could be related to the movement of intestinal gas or the position affecting bowel habits.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Symptoms can include chest and abdominal discomfort that may worsen with certain positions, such as lying down or bending over, which could align with the described worsening when laying on the right side.
- Functional Dyspepsia: This condition involves upper abdominal discomfort or pain that is not explained by other diseases. Symptoms can be exacerbated by eating or by certain positions.
- Splenic Flexure Syndrome: Although less common, this condition involves gas accumulation in the splenic flexure of the colon, which could cause left upper quadrant abdominal discomfort that might worsen with position changes.
Do Not Miss Diagnoses
- Pancreatitis: Both acute and chronic pancreatitis can cause severe abdominal pain that radiates to the back and worsens when lying down. Although less likely given the intermittent nature of the symptoms, pancreatitis is a serious condition that should not be missed.
- Gallbladder Disease: Gallstones or cholecystitis can cause right upper quadrant pain but can sometimes refer pain to the left side, especially if a stone migrates. The worsening of symptoms with position could be related to the movement of stones.
- Cardiac Ischemia: Although the location and nature of the pain might not typically suggest cardiac ischemia, atypical presentations can occur, especially in women. Cardiac conditions are critical not to miss due to their potential for severe outcomes.
Rare Diagnoses
- Splenomegaly: Enlargement of the spleen due to various causes (infection, hematologic disorders, etc.) could cause left upper quadrant discomfort. However, this would typically be associated with other systemic symptoms.
- Left Diaphragmatic Hernia: A rare condition where abdominal contents herniate through the diaphragm, potentially causing intermittent abdominal pain that could worsen with position changes.
- Intestinal Obstruction: Although typically presenting with more acute symptoms, a partial or intermittent obstruction could cause chronic, intermittent abdominal pain that worsens with certain positions.
Each diagnosis should be considered in the context of a thorough medical history, physical examination, and appropriate diagnostic testing to determine the underlying cause of the symptoms.