Differential Diagnosis for 92M with Sudden Onset Nausea and Vomiting
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD) or gastritis: Given the sudden onset of nausea and vomiting without changes in bowel habits or fever, and in the absence of other alarming symptoms, a gastrointestinal cause such as GERD or gastritis is plausible. The patient's age and the lack of other symptoms make this a common and likely diagnosis.
Other Likely Diagnoses
- Medication side effect: The patient could be experiencing nausea and vomiting as a side effect of medications, especially considering his age and potential for polypharmacy. Many medications can cause gastrointestinal upset.
- Viral gastroenteritis: Although the patient is afebrile and has no changes in bowel habits, viral gastroenteritis can sometimes present atypically, especially in the elderly.
- Functional gastrointestinal disorder: Conditions like functional dyspepsia could also be considered, given the absence of other symptoms.
Do Not Miss Diagnoses
- Myocardial infarction (MI): Despite the ECG showing an old inferior infarction and no chest pain, it's crucial not to miss an acute MI, especially in a patient with a history of cardiac disease. Atypical presentations are more common in the elderly.
- Mesenteric ischemia: This is a life-threatening condition that can present with nausea and vomiting, especially in older patients with cardiovascular disease. The absence of abdominal pain does not rule out this diagnosis.
- Increased intracranial pressure (ICP): Although there are no stroke symptoms, conditions causing increased ICP can present with nausea and vomiting. This would be particularly concerning in the absence of other explanations.
Rare Diagnoses
- Cyclic vomiting syndrome: A rare condition characterized by recurrent episodes of severe vomiting, which could be considered if other causes are ruled out.
- Neurological disorders: Rare neurological conditions such as a brain tumor or certain types of migraine could present with nausea and vomiting, although these would be less likely without other neurological symptoms.
- Endocrine disorders: Certain endocrine disorders, like adrenal insufficiency, can cause nausea and vomiting, but these would typically be accompanied by other systemic symptoms.