What is the differential diagnosis for a 36-year-old female presenting with acute right lower quadrant abdominal pain, nausea, loss of appetite, and mild bloating, with a recent history of starting Zepbound (tirzepatide) for weight loss?

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Differential Diagnosis for B.C.

  • Single most likely diagnosis
    • Appendicitis: The patient's presentation of acute right lower quadrant abdominal pain, nausea, loss of appetite, and mild bloating is classic for appendicitis. The sharp, localized, and constant nature of the pain further supports this diagnosis.
  • Other Likely diagnoses
    • Gastroenteritis: Although the patient denies vomiting, diarrhea, or urinary symptoms, gastroenteritis could still be a consideration, especially given the recent introduction of a new medication (Zepbound) that may be causing GI side effects.
    • Intestinal obstruction: The patient's symptoms of constipation, cramping, and bloating, which have worsened since starting Zepbound, could suggest an intestinal obstruction, particularly if the medication has caused a significant change in bowel habits.
    • Mesenteric lymphadenitis: This condition, also known as mesenteric adenitis, can mimic appendicitis and is often associated with gastrointestinal symptoms such as nausea, vomiting, and abdominal pain.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Ectopic pregnancy: Although the patient's presentation does not strongly suggest pregnancy, it is crucial to consider ectopic pregnancy in any female of childbearing age presenting with acute abdominal pain, as it is a life-threatening condition.
    • Ovarian torsion: This is another potentially life-threatening condition that can cause severe abdominal pain and should be considered, especially in the absence of a clear diagnosis.
    • Diverticulitis: While less common in younger patients, diverticulitis can cause severe abdominal pain and should be considered, particularly if the patient has a history of diverticulosis or other risk factors.
  • Rare diagnoses
    • Intussusception: A rare condition in adults, intussusception occurs when a part of the intestine telescopes into another part, causing bowel obstruction and potentially severe abdominal pain.
    • Meckel's diverticulum: A congenital anomaly of the small intestine, Meckel's diverticulum can cause abdominal pain, nausea, and vomiting, particularly if it becomes inflamed or obstructed.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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