Differential Diagnosis for Patient with Persistent Nausea and Vomiting
Single Most Likely Diagnosis
- Cannabinoid Hyperemesis Syndrome (CHS): This condition is characterized by recurrent episodes of severe vomiting, often accompanied by abdominal pain, and is associated with long-term marijuana use. The patient's history of marijuana use and symptoms of persistent nausea and vomiting for 6 days support this diagnosis.
Other Likely Diagnoses
- Acute Pancreatitis: Although the lipase level is within normal limits, the patient's symptoms of nausea and vomiting, along with the history of cholecystectomy, could suggest pancreatitis. However, the normal lipase level makes this diagnosis less likely.
- Gallstone Pancreatitis (unlikely due to cholecystectomy): Given the patient's history of cholecystectomy, this diagnosis is less likely, but it's still possible if there are residual gallstones in the bile ducts.
- Hepatitis: The elevated liver enzymes (ALT-SGPT 120, AST-SGOT 57) could indicate hepatitis, which may be related to the patient's marijuana use or other factors.
Do Not Miss Diagnoses
- Appendicitis: Although the patient's symptoms do not typically suggest appendicitis, it's essential to consider this diagnosis due to its potential severity and the need for prompt surgical intervention.
- Bowel Obstruction: The patient's history of nausea and vomiting could be indicative of a bowel obstruction, which requires immediate medical attention.
- Peptic Ulcer Disease: The patient's symptoms and laboratory results could be consistent with peptic ulcer disease, which can be a life-threatening condition if not properly managed.
Rare Diagnoses
- Zollinger-Ellison Syndrome: This rare condition is characterized by excessive gastric acid production, leading to severe nausea and vomiting. However, it's unlikely given the patient's presentation and laboratory results.
- Intra-abdominal Infection (e.g., abscess): Although rare, an intra-abdominal infection could be a possible cause of the patient's symptoms, especially if there's a history of recent surgery or trauma.