Differential Diagnosis for an 83-year-old Female with Hypertension and Symptoms

Single Most Likely Diagnosis

• Hypertensive Emergency: Given the significantly elevated blood pressure (192/119) along with symptoms such as vomiting, dizziness, and abdominal pain, a hypertensive emergency is the most likely diagnosis. This condition requires immediate medical attention to prevent organ damage.

Other Likely Diagnoses

• Gastroenteritis: The symptoms of vomiting and abdominal pain could suggest gastroenteritis, especially if the patient has been exposed to a gastrointestinal pathogen. However, the high blood pressure would need to be addressed concurrently.
• Urinary Tract Infection (UTI): UTIs can cause abdominal pain and vomiting, especially in elderly patients, and can also lead to or exacerbate hypertension due to pain and stress.
• Dehydration: Possibly leading to or exacerbating the hypertension and causing symptoms like dizziness and vomiting, especially if the patient has not been able to keep fluids down due to vomiting.

Do Not Miss Diagnoses

• Aortic Dissection: Although less likely, this is a potentially deadly condition that must be considered, especially with the high blood pressure. Symptoms can include severe abdominal or back pain and dizziness.
• Intracranial Hemorrhage: Hypertension is a risk factor for intracranial hemorrhage, which could explain the dizziness and vomiting. Immediate diagnosis and treatment are crucial.
• Myocardial Infarction: The high blood pressure and symptoms like dizziness could be indicative of a myocardial infarction, especially if there are associated chest pains or shortness of breath.
• Pulmonary Embolism: Could present with dizziness and abdominal pain if associated with significant hypoxia or if the embolism is large enough to cause hemodynamic instability.

Rare Diagnoses

• Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, abdominal pain, and vomiting. It's less likely but should be considered if other causes are ruled out.
• Cushing's Syndrome: Another rare condition that can cause hypertension, abdominal pain, and potentially vomiting due to the high levels of cortisol.
• Hyperthyroidism: Can cause hypertension, vomiting, and abdominal pain, though it's less common in this presentation, especially in an elderly patient.