Differential Diagnosis for Projectile Vomiting in Adults
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD) - This is a common condition where stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus). This backwash (acid reflux) can cause discomfort and may lead to vomiting.
Other Likely Diagnoses
- Peptic ulcer disease - Ulcers in the stomach or duodenum can cause vomiting, especially if they bleed or perforate.
- Gastritis - Inflammation of the stomach lining can lead to vomiting.
- Food poisoning - Consuming contaminated food can cause sudden onset of vomiting.
- Viral gastroenteritis - Infections like norovirus can cause severe vomiting.
- Intestinal obstruction - A blockage in the intestines can lead to vomiting, especially if it's a high obstruction.
Do Not Miss Diagnoses
- Appendicitis - Although more commonly associated with abdominal pain, vomiting can be a presenting symptom, especially if the appendix is located near the stomach or duodenum.
- Pancreatitis - Inflammation of the pancreas can cause severe vomiting and is a medical emergency.
- Cholecystitis - Inflammation of the gallbladder can cause vomiting, especially after eating fatty foods.
- Pyloric stenosis - A narrowing of the pylorus, the opening from the stomach into the small intestine, can cause projectile vomiting and is more common in infants but can occur in adults.
Rare Diagnoses
- Zollinger-Ellison syndrome - A rare disorder characterized by excessive gastric acid production, leading to severe ulcers and vomiting.
- Eosinophilic gastroenteritis - A rare condition where eosinophils (a type of white blood cell) infiltrate the stomach or intestines, causing inflammation and vomiting.
- Gastric cancer - Although rare, stomach cancer can cause vomiting, especially if it obstructs the stomach or causes a gastric outlet obstruction.
- Neurological disorders (e.g., increased intracranial pressure, brain tumors) - In rare cases, neurological conditions can cause vomiting, including projectile vomiting, due to increased pressure or direct effects on the brain's vomiting centers.