Differential Diagnosis for a 9-year-old Premenarchal Female with Intermittent Episodes of Nausea and Vomiting
- Single most likely diagnosis:
- Cyclic Vomiting Syndrome (CVS): This condition is characterized by recurrent, episodic bouts of severe nausea and vomiting, often occurring at the same time of day or month, without an obvious cause. The symptoms described, such as morning nausea and vomiting without significant abdominal pain, occurring twice a month, and resolving by mid-morning, are consistent with CVS. The absence of fever, other systemic symptoms, and a negative H. pylori breath test further supports this diagnosis.
- Other Likely diagnoses:
- Functional Nausea and Vomiting: This condition involves recurrent nausea and vomiting without an identifiable cause, fitting the patient's symptoms of intermittent episodes of nausea and vomiting without obvious triggers.
- Irritable Bowel Syndrome (IBS): Although IBS typically presents with abdominal pain, some patients may experience nausea and vomiting, especially if they have a predominant diarrhea subtype (IBS-D), which could explain the occasional diarrhea.
- Food Intolerance or Sensitivity: The symptoms occurring after breakfast could suggest an intolerance or sensitivity to certain foods consumed at that time, leading to nausea, vomiting, and sometimes diarrhea.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can present with nausea, vomiting, and diarrhea. Although less common in premenarchal females without significant abdominal pain, missing this diagnosis could lead to severe complications.
- Gastroesophageal Reflux Disease (GERD): While GERD is more commonly associated with heartburn, some patients may experience nausea and vomiting, especially after eating. It's crucial not to miss this diagnosis due to potential long-term complications like esophageal stricture.
- Diabetic Ketoacidosis (DKA): Although the patient does not have fever or other systemic symptoms, DKA can occasionally present with nausea and vomiting. Given the potential severity of DKA, it's essential to consider and rule out, especially if there's any suspicion of diabetes mellitus.
- Rare diagnoses:
- Gastroparesis: A condition characterized by delayed stomach emptying, which can cause nausea, vomiting, and sometimes diarrhea. It's less common in children without underlying conditions like diabetes but should be considered if other diagnoses are ruled out.
- Mitochondrial Disorders: Certain mitochondrial disorders can present with cyclic vomiting syndrome-like symptoms. These are rare genetic conditions that affect the mitochondria, often requiring specialized testing for diagnosis.