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Differential Diagnosis for Epigastric Inflammation and Vomiting in a 3-Week-Old Infant

Single Most Likely Diagnosis

  • Pyloric Stenosis: This condition is characterized by the thickening of the pylorus muscle, leading to gastric outlet obstruction. It typically presents with projectile vomiting after feeding, which can lead to dehydration and electrolyte imbalance. The age of presentation, around 3 weeks, and the symptoms of epigastric inflammation and vomiting, make pyloric stenosis a highly likely diagnosis.

Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): Although more common in older infants, GERD can cause epigastric discomfort and vomiting due to the reflux of stomach contents into the esophagus.
  • Infectious Gastroenteritis: Viral or bacterial infections can cause inflammation of the stomach and intestines, leading to vomiting and epigastric discomfort.
  • Food Protein-Induced Allergic Proctocolitis (FPIAP): An allergic reaction to certain proteins in the diet can cause inflammation and lead to symptoms like vomiting.

Do Not Miss Diagnoses

  • Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially cutting off blood supply. It's a surgical emergency and can present with vomiting, abdominal pain, and sometimes currant jelly stool.
  • Volvolus: A twisting of a portion of the intestine that can cut off blood supply, leading to tissue death. It's a surgical emergency that requires immediate attention.
  • Hirschsprung's Disease: A congenital condition affecting the large intestine, leading to severe constipation or intestinal obstruction. While less common, it's crucial not to miss due to its implications for bowel function and the need for surgical intervention.

Rare Diagnoses

  • Congenital Anomalies of the Gastrointestinal Tract: Conditions such as duodenal atresia, stenosis, or other congenital anomalies can cause vomiting and abdominal distress.
  • Metabolic Disorders: Certain metabolic disorders can present with gastrointestinal symptoms, including vomiting, due to the accumulation of toxic substances.
  • Neonatal Hemochromatosis: A rare condition of iron overload that can cause liver dysfunction and potentially lead to gastrointestinal symptoms.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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