Differential Diagnosis for 14 y.o. with N/V, Diarrhea, Abdominal Pain
- Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): The worsening of vomiting at night and upon waking, relieved by standing, suggests GERD. The absence of fever and abnormalities in emesis also points towards a non-infectious cause like GERD.
- Other Likely Diagnoses
- Functional dyspepsia: This condition is characterized by recurrent abdominal pain and nausea, which can be exacerbated by eating or relieved by vomiting. The absence of fever and dark stool could be indicative of a non-ulcer, non-inflammatory cause.
- Irritable bowel syndrome (IBS): IBS can cause abdominal pain, diarrhea, and nausea. However, the specific pattern of vomiting worsening at night and improving with standing is less typical for IBS.
- Peptic ulcer disease: Although less common in adolescents, peptic ulcers can cause abdominal pain, nausea, and vomiting. The dark stool could indicate gastrointestinal bleeding, but the absence of fever and other symptoms makes this less likely.
- Do Not Miss Diagnoses
- Appendicitis: Although the patient denies fever, appendicitis can present atypically, especially in adolescents. The abdominal pain and nausea could be indicative of appendicitis, and missing this diagnosis could be catastrophic.
- Intussusception: This condition involves the telescoping of a portion of the intestine into another, causing abdominal pain, vomiting, and potentially bloody stools. Although rare in adolescents, it is a medical emergency that requires prompt attention.
- Inflammatory bowel disease (IBD): IBD, including Crohn's disease and ulcerative colitis, can cause abdominal pain, diarrhea, and vomiting. The dark stool could indicate gastrointestinal bleeding, and missing this diagnosis could lead to significant morbidity.
- Rare Diagnoses
- Gastric volvulus: This rare condition involves the twisting of the stomach, causing severe abdominal pain, nausea, and vomiting. The worsening of symptoms at night and improvement with standing could be indicative of gastric volvulus.
- Eosinophilic esophagitis: This condition is characterized by an allergic inflammatory response in the esophagus, causing abdominal pain, nausea, and vomiting. Although rare, it could be considered in the differential diagnosis, especially if other causes are ruled out.