Differential Diagnosis for a 30-year-old Female with Nausea and Upset Stomach

The patient presents with nausea, upset stomach, and occasional cold sweats, without fever, chest pain, or shortness of breath. She has a history of a recent miscarriage and has been trying to get established with a new OB/GYN. Given her symptoms and history, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Pregnancy: Given her recent miscarriage and the fact that she and her partner have been having protected sex but not strictly preventing pregnancy, there's a possibility she could be pregnant again. Morning sickness is a common symptom of early pregnancy, which aligns with her nausea and upset stomach.
• Other Likely Diagnoses
  • Gastroenteritis: This is an inflammation of the stomach and intestines, typically caused by a bacterial or viral infection, leading to symptoms like nausea, vomiting, and stomach upset.
  • Functional Dyspepsia: A condition characterized by recurring signs and symptoms of indigestion that have no obvious cause. Symptoms can include nausea, bloating, and stomach discomfort.
  • Irritable Bowel Syndrome (IBS): Although the patient denies changes in bowel habits, IBS can sometimes present with nausea and abdominal discomfort as primary symptoms.
• Do Not Miss Diagnoses
  • Ectopic Pregnancy: Given her history of miscarriage and potential for current pregnancy, an ectopic pregnancy is a critical diagnosis not to miss. It presents with abdominal pain, nausea, and can lead to severe complications if not promptly treated.
  • Appendicitis: Although the patient denies abdominal pain, which is a hallmark of appendicitis, the condition can sometimes present atypically, especially in women of childbearing age. It's crucial to consider due to its potential for severe consequences if not treated.
  • Gallbladder Disease: Conditions like cholecystitis or gallstones can cause nausea, vomiting, and abdominal pain, often worsened by fatty foods. Cold sweats can accompany severe pain episodes.
• Rare Diagnoses
  • Adrenal Insufficiency: A condition where the adrenal glands do not produce adequate amounts of certain hormones, leading to a variety of symptoms including nausea, vomiting, and abdominal pain.
  • Cyclic Vomiting Syndrome: A disorder characterized by recurrent episodes of severe nausea and vomiting, which can be triggered by various factors including stress, and can be associated with abdominal pain and other symptoms.

Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and appropriate diagnostic testing to determine the underlying cause of her symptoms.