Differential Diagnosis for Vomiting and Epigastric Pain in a Woman at 10 Weeks Being Treated for Severe Asthma with Oral Prednisolone
- Single Most Likely Diagnosis
- Peptic ulcer disease: The use of oral prednisolone, a corticosteroid, can increase the risk of peptic ulcers, especially when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), which are sometimes used in asthma management. The symptoms of vomiting and epigastric pain are classic for peptic ulcer disease.
- Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): Asthma and GERD often coexist, and the symptoms can be exacerbated by asthma treatments or the condition itself. Vomiting and epigastric pain can be associated with GERD.
- Pregnancy-related nausea and vomiting: Although the patient is at 10 weeks of gestation, nausea and vomiting are common symptoms during early pregnancy. Epigastric pain could be related to the pregnancy itself or other gastrointestinal issues exacerbated by pregnancy.
- Do Not Miss Diagnoses
- Ectopic pregnancy: Although less likely given the context, ectopic pregnancy is a life-threatening condition that must be considered in any pregnant woman presenting with abdominal pain and vomiting. The risk may be lower at 10 weeks, but it's crucial not to miss this diagnosis.
- Appendicitis: Appendicitis can present with epigastric pain that migrates to the lower right quadrant and is accompanied by vomiting. It's a surgical emergency that requires prompt diagnosis.
- Pneumonia or other pulmonary infections: Given the patient's history of severe asthma, any respiratory infection could potentially lead to vomiting and epigastric pain, either directly or through the use of medications like prednisolone that can mask symptoms.
- Rare Diagnoses
- Gastric cancer: Although rare, especially in younger individuals, gastric cancer can present with vomiting and epigastric pain. The use of corticosteroids might complicate the diagnosis.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause gastrointestinal symptoms, including vomiting and abdominal pain. They might be less common but should be considered, especially if other diagnoses are ruled out.