Differential Diagnosis
The patient's presentation with diarrhea, nausea, elevated ALTs, elevated B12, joint pain, sharp pain in left abdomen, elevated BUN/creatinine, slight total albumin elevation, and elevated IgG suggests a complex underlying condition. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Chronic Hepatitis or Liver Disease: The combination of elevated ALTs, slight albumin elevation, and other symptoms could indicate liver inflammation or damage, possibly due to hepatitis or another liver condition. Elevated IgG levels can also be seen in chronic hepatitis.
- Other Likely diagnoses
- Inflammatory Bowel Disease (IBD): Diarrhea, nausea, joint pain, and abdominal pain are common in IBD, such as Crohn's disease or ulcerative colitis. Elevated IgG and liver enzymes could be related to the inflammatory process.
- Celiac Disease: This autoimmune disorder can cause diarrhea, abdominal pain, and elevated liver enzymes. Joint pain and elevated IgG levels are also possible.
- Rheumatologic Disorders (e.g., Rheumatoid Arthritis, Lupus): These conditions can cause joint pain, elevated IgG, and potentially affect other systems, leading to some of the patient's symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis or Bacterial Infection: Elevated BUN/creatinine and sharp abdominal pain could indicate a severe infection, which would require immediate attention.
- Pancreatitis: Severe abdominal pain, elevated liver enzymes, and other symptoms could suggest pancreatitis, a potentially life-threatening condition.
- Lymphoma: Although less likely, lymphoma could explain elevated IgG, liver enzyme abnormalities, and some of the other symptoms.
- Rare diagnoses
- Whipple's Disease: A rare bacterial infection that can cause diarrhea, joint pain, and abdominal pain, along with elevated IgG and liver enzyme abnormalities.
- Amyloidosis: A condition characterized by the deposition of abnormal proteins, which could lead to elevated IgG, liver enzyme abnormalities, and other symptoms.
- Sarcoidosis: A rare autoimmune disorder that can affect multiple systems, potentially causing some of the patient's symptoms, including elevated IgG and liver enzyme abnormalities.