What is the diagnosis for a patient with a history of marijuana use, presenting with persistent nausea and vomiting, hyperbilirubinemia, glucosuria, proteinuria, and abnormal liver function tests, including elevated Alanine Transaminase (ALT) and Aspartate Transaminase (AST), 6 years after a cholecystectomy?

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, combined with the history of cholecystectomy, could suggest pancreatitis. However, the normal lipase level makes this diagnosis less likely.
• Gallstone Pancreatitis (unlikely due to cholecystectomy, but possible if patient has a residual gallbladder or choledocholithiasis): The patient's history of cholecystectomy reduces the likelihood of this diagnosis, but it is still possible if there are residual gallstones in the bile ducts.
• Hepatitis: The elevated liver enzymes (ALT and AST) could indicate hepatitis, which may be related to the patient's marijuana use or other factors.

Do Not Miss Diagnoses

• Obstructive Jaundice: The presence of bilirubin in the urine and elevated liver enzymes could indicate obstructive jaundice, which is a serious condition that requires prompt attention. Although the patient had a cholecystectomy, it is still possible to have obstructive jaundice due to other causes, such as a tumor or stricture.
• Diabetic Ketoacidosis (DKA): The presence of glucose, ketones, and protein in the urine could suggest DKA, which is a life-threatening condition that requires immediate treatment.
• Sepsis: Although there is no clear indication of sepsis in the provided information, it is always important to consider this diagnosis in patients with persistent nausea and vomiting, as sepsis can be a life-threatening condition.

Rare Diagnoses

• Zollinger-Ellison Syndrome: This rare condition is characterized by excessive gastric acid production, which can cause nausea, vomiting, and abdominal pain. However, this diagnosis is unlikely without other supporting evidence, such as a history of peptic ulcers or diarrhea.
• Porphyria: This group of rare disorders can cause abdominal pain, nausea, and vomiting, but is unlikely without other supporting evidence, such as a family history or specific laboratory findings.