Differential Diagnosis for 18-year-old Female with Vomiting

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD) with possible exacerbation by marijuana use: The patient's history of abdominal issues since childhood, recent onset of vomiting that is temporarily relieved by Zofran (an antiemetic), and occasional heartburn suggest GERD. Marijuana use can exacerbate GERD symptoms.

Other Likely Diagnoses

• Cyclic Vomiting Syndrome (CVS): Given the patient's history of abdominal issues and the cyclic nature of her vomiting, CVS is a possibility. CVS is characterized by recurrent episodes of severe vomiting lasting hours to days, with periods of normal health in between.
• Irritable Bowel Syndrome (IBS): Although IBS typically presents with abdominal pain and altered bowel habits, some patients may experience nausea and vomiting. The patient's long history of abdominal issues could suggest IBS.
• Food Poisoning or Gastroenteritis: The onset of symptoms after consuming a Burger King meal could suggest food poisoning or gastroenteritis, although the prolonged duration of symptoms makes this less likely.

Do Not Miss Diagnoses

• Pregnancy-related complications (e.g., hyperemesis gravidarum): Although the initial pregnancy test was negative, it is crucial to consider the possibility of a false negative or a pregnancy that has developed since the test. Hyperemesis gravidarum is a condition characterized by severe nausea and vomiting during pregnancy.
• Appendicitis or other surgical emergencies: Although the patient's symptoms have been ongoing for two weeks, it is essential to rule out appendicitis or other surgical emergencies, which can present with nausea, vomiting, and abdominal pain.
• Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis): These conditions can cause chronic abdominal symptoms, including nausea, vomiting, and changes in bowel habits.

Rare Diagnoses

• Gastroparesis: A condition characterized by delayed gastric emptying, which can cause nausea, vomiting, and abdominal bloating. It is often associated with diabetes, but can also be idiopathic.
• Eosinophilic esophagitis: A rare condition characterized by inflammation of the esophagus, which can cause nausea, vomiting, and difficulty swallowing.
• Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): A rare genetic disorder that affects the digestive system and nervous system, causing symptoms such as nausea, vomiting, and abdominal pain.