Differential Diagnosis for Bilious Vomiting in an HIV Patient
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): Given the high prevalence of GERD in the general population and its potential exacerbation by certain antiretroviral therapies or opportunistic infections in HIV patients, GERD is a common cause of bilious vomiting in this group.
Other Likely Diagnoses
- Opportunistic infections: Such as CMV esophagitis or gastroenteritis, which can cause severe gastrointestinal symptoms including bilious vomiting in immunocompromised HIV patients.
- Medication side effects: Certain antiretroviral drugs or medications used to treat opportunistic infections can cause gastrointestinal side effects, including bilious vomiting.
- HIV-related gastrointestinal malignancies: Like lymphoma or Kaposi's sarcoma, which can involve the gastrointestinal tract and cause obstructive symptoms leading to bilious vomiting.
Do Not Miss Diagnoses
- Intestinal obstruction: Due to various causes such as adhesions, hernias, or malignancies, which requires prompt surgical intervention to prevent severe complications.
- Acute pancreatitis: Can be caused by antiretroviral therapy, opportunistic infections, or other factors, and is a medical emergency.
- Perforated viscus: A life-threatening condition that requires immediate surgical attention, which can be caused by advanced HIV disease affecting the gastrointestinal tract.
Rare Diagnoses
- Whipple's disease: A rare systemic bacterial infection that can cause malabsorption and gastrointestinal symptoms, including bilious vomiting, in immunocompromised patients.
- AIDS-related cholangiopathy: A condition characterized by bile duct abnormalities and obstruction, leading to bilious vomiting, seen in advanced HIV disease.
- Gastrointestinal lymphoma: Although mentioned under other likely diagnoses due to its association with HIV, it's relatively rare compared to other causes and requires specific diagnostic consideration.