Differential Diagnosis for a 16-year-old Male with Epigastric Pain and Vomiting
The patient's symptoms of epigastric pain, vomiting, and diarrhea, particularly after eating, suggest a gastrointestinal issue. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Gastroesophageal reflux disease (GERD): The patient's symptoms of epigastric pain and vomiting, especially after eating, are consistent with GERD. The fact that he can hold down liquids but has trouble with solid food also supports this diagnosis.
- Other Likely diagnoses
- Peptic ulcer disease: The patient's epigastric pain and vomiting could be indicative of a peptic ulcer, especially if he has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) or has a history of Helicobacter pylori infection.
- Viral gastroenteritis: Although the patient's symptoms have lasted for a week, viral gastroenteritis is still a possibility, especially given the presence of diarrhea.
- Functional dyspepsia: This condition is characterized by recurring epigastric pain or discomfort, which could be related to eating, and may be a possibility if other diagnoses are ruled out.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the patient's symptoms are primarily epigastric, appendicitis can sometimes present with upper abdominal pain, and it's essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Intestinal obstruction: The patient's vomiting and abdominal pain could be indicative of an intestinal obstruction, which would require prompt surgical intervention.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can present with abdominal pain, vomiting, and diarrhea, and it's crucial to consider these diagnoses to avoid delaying treatment.
- Rare diagnoses
- Gastric cancer: Although extremely rare in a 16-year-old, gastric cancer can present with epigastric pain, vomiting, and weight loss, and should be considered if other diagnoses are ruled out and symptoms persist.
- Eosinophilic esophagitis: This condition is characterized by inflammation of the esophagus and can present with dysphagia, food impaction, and epigastric pain, but is relatively rare in adolescents.
- Zollinger-Ellison syndrome: This rare condition is characterized by excessive gastric acid production and can present with epigastric pain, vomiting, and diarrhea, but is unlikely in a 16-year-old without a family history or other suggestive features.