Differential Diagnosis for Prolonged Nausea
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): Prolonged nausea can be a symptom of GERD, which is common in adults and can be exacerbated by certain medications, including biologics like Humira. The chronic nature of the nausea and the lack of an obvious infectious cause make GERD a plausible explanation.
Other Likely Diagnoses
- Humira Side Effects: As the patient is on Humira, a biologic medication used for autoimmune diseases, it's possible that the nausea is a side effect of the medication itself. Biologics can cause gastrointestinal symptoms, including nausea.
- Irritable Bowel Syndrome (IBS): IBS is a common condition that can cause chronic nausea, among other symptoms like abdominal pain and changes in bowel habits. Stress, diet, and other factors can exacerbate IBS symptoms.
- Inflammatory Bowel Disease (IBD): Given the patient's use of Humira, which is often prescribed for IBD (including Crohn's disease and ulcerative colitis), it's possible that the nausea is related to an flare-up or inadequate control of the underlying IBD.
Do Not Miss Diagnoses
- Infectious Diseases (e.g., Giardiasis): Although less likely, infectious diseases such as giardiasis can cause prolonged nausea. Given the patient's exposure to pet ducks, which can be a source of Giardia, this diagnosis should not be missed as it can have significant health implications if left untreated.
- Gastric Cancer: While rare, gastric cancer can present with nonspecific symptoms like nausea. It's crucial to consider this diagnosis, especially if other symptoms like weight loss or abdominal pain are present.
- Medication-Induced Liver Injury: Certain medications, including biologics, can cause liver injury, leading to nausea among other symptoms. Early detection is critical to prevent serious outcomes.
Rare Diagnoses
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause nausea, abdominal pain, and other symptoms.
- Cyclic Vomiting Syndrome: A disorder characterized by recurrent episodes of severe nausea and vomiting, which can be debilitating but is relatively rare.
- Duck-Related Zoonoses (e.g., Cryptococcosis, Campylobacteriosis): While extremely rare, certain infections can be transmitted from ducks to humans, potentially causing nausea among other symptoms. However, these would be unusual causes of prolonged nausea without other significant symptoms.