Differential Diagnosis for Recurrent Vomiting in a 9-Year-Old Girl
Single Most Likely Diagnosis
- Cyclic Vomiting Syndrome (CVS): This condition is characterized by recurrent, severe episodes of vomiting that are separated by periods of normal health. The pattern of vomiting described, particularly the cyclical nature and the fact that it occurs at the same time of day, is highly suggestive of CVS. The absence of other symptoms during episodes and the normal growth pattern also support this diagnosis.
Other Likely Diagnoses
- Functional Gastrointestinal Disorder: Disorders such as functional dyspepsia or irritable bowel syndrome could present with abdominal pain and vomiting, although the cyclical pattern is more indicative of CVS.
- Gastroesophageal Reflux Disease (GERD): While GERD can cause vomiting, it typically does not follow a cyclical pattern and may be associated with other symptoms like heartburn or regurgitation.
- Food Allergies or Intolerances: Could potentially cause recurrent vomiting, especially if the episodes are triggered by specific foods. However, the cyclical nature and lack of other symptoms make this less likely.
Do Not Miss Diagnoses
- Diabetic Ketoacidosis: Although less likely given the absence of fever, headache, or other systemic symptoms, diabetic ketoacidosis can present with vomiting and must be considered due to its potential severity.
- Intracranial Hypertension or Tumors: Vomiting, especially in the morning, can be a sign of increased intracranial pressure. The normal neurologic examination does not rule out this possibility entirely.
- Urea Cycle Disorders or Other Metabolic Disorders: These can cause recurrent vomiting and are critical to diagnose early due to their potential for severe outcomes.
Rare Diagnoses
- Mitochondrial Disorders: Certain mitochondrial disorders can present with cyclical vomiting syndrome among other symptoms. These are rare but important to consider in the differential diagnosis.
- Chronic Intestinal Pseudo-obstruction: A rare condition characterized by recurrent episodes of abdominal pain, vomiting, and constipation due to impaired intestinal motility.
- Eosinophilic Gastroenteritis: A rare condition involving eosinophilic infiltration of the gastrointestinal tract, which can cause vomiting, abdominal pain, and other gastrointestinal symptoms.