Differential Diagnosis

The patient's symptoms of recurrent episodes of nausea, stomach pain, dry heaving, and abdominal discomfort that worsens when lying on the left side suggest a gastrointestinal issue. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Gastroesophageal Reflux Disease (GERD): The symptoms of nausea, stomach pain, and dry heaving, especially when lying down, are consistent with GERD. The fact that the patient experiences more pain on the left side when lying down could be related to the positioning of the stomach and the exacerbation of reflux.
• Other Likely diagnoses
  • Gastritis: Inflammation of the stomach lining could cause the described symptoms, including pain, nausea, and dry heaving. The absence of vomiting might suggest a more chronic or low-grade inflammation.
  • Peptic Ulcer Disease: A peptic ulcer could cause abdominal pain, nausea, and vomiting. The pain worsening when lying on the left side might indicate an ulcer in the duodenum or stomach that is irritated by this position.
  • Irritable Bowel Syndrome (IBS): Although IBS typically presents with a mix of abdominal pain, bloating, and changes in bowel habits, some patients might experience nausea and dry heaving, especially if they have a predominant dyspeptic symptom profile.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Appendicitis: Although the pain is described as being on the left side, appendicitis typically presents with right lower quadrant pain. However, a retrocecal appendix could potentially cause left-sided pain, and the nausea, vomiting, and abdominal pain could be consistent with appendicitis.
  • Pancreatitis: Acute pancreatitis can cause severe abdominal pain, nausea, vomiting, and can be exacerbated by lying down. The pain is often in the upper abdomen and radiates to the back.
  • Intestinal Obstruction: This condition can cause severe abdominal pain, nausea, vomiting, and could lead to dry heaving if the obstruction is partial or the patient is not able to vomit.
• Rare diagnoses
  • Gastroparesis: A condition where the stomach takes too long to empty its contents, which can cause nausea, vomiting, and abdominal pain. It might not typically cause dry heaving without vomiting, but it's a possibility in some cases.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause a wide range of gastrointestinal symptoms, including abdominal pain, nausea, and changes in bowel habits. Dry heaving could be a part of the symptom complex, especially during flare-ups.

Each of these diagnoses should be considered and investigated based on the patient's full clinical picture, including additional symptoms, medical history, physical examination findings, and diagnostic tests as appropriate.