History of Present Illness (HPI)

The patient is an 18-year-old female who presents with a 2-week history of vomiting, unable to keep down solids or liquids. She initially visited the ER, where she was given Zofran and underwent a pregnancy test, which was negative. The Zofran provided temporary relief but did not completely resolve her symptoms. She has a history of abdominal issues since childhood, which have been controlled. Recently, she reported smoking marijuana and consuming a Burger King meal around the time her symptoms started. Her last bowel movement was 2 days ago, and she occasionally experiences heartburn.

Differential Diagnosis

• Single Most Likely Diagnosis
  • Gastroesophageal Reflux Disease (GERD): Given her history of abdominal issues, occasional heartburn, and the onset of symptoms after eating, GERD is a plausible diagnosis. The fact that Zofran provides temporary relief suggests that her symptoms might be related to gastric motility or reflux.
• Other Likely Diagnoses
  • Cyclic Vomiting Syndrome: This condition is characterized by recurrent episodes of severe vomiting, often with a history of similar episodes in the past. The patient's history of abdominal issues and the pattern of her vomiting suggest this could be a possibility.
  • Gastroparesis: This condition involves delayed gastric emptying, which could explain her inability to keep down solids or liquids. Her history of controlled abdominal issues and the recent onset of severe vomiting make this a consideration.
  • Marijuana Hyperemesis Syndrome: Given her reported use of marijuana, this syndrome, which involves recurrent episodes of severe vomiting in chronic marijuana users, should be considered.
• Do Not Miss Diagnoses
  • Appendicitis: Although less likely given the duration and nature of her symptoms, appendicitis can present atypically, especially in young females, and is a diagnosis that could have severe consequences if missed.
  • Intestinal Obstruction: This is a serious condition that requires immediate attention. Although her symptoms do not strongly suggest obstruction (given the lack of abdominal pain and the fact that she has had a bowel movement), it cannot be entirely ruled out without further investigation.
  • Pregnancy-related Conditions: Despite the initial negative pregnancy test, the possibility of a pregnancy-related condition, such as a molar pregnancy or an ectopic pregnancy, should not be entirely dismissed without confirming the patient's current pregnancy status.
• Rare Diagnoses
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis could present with vomiting, abdominal issues, and altered bowel habits. However, these conditions are less common and would typically be associated with other symptoms like diarrhea, weight loss, and abdominal pain.
  • Neurological Disorders: Certain neurological conditions, such as brain tumors or migraines, can cause cyclic vomiting. These would be rare causes of her symptoms but should be considered if other diagnoses are ruled out.