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Differential Diagnosis for Recurring Abdominal Pain, Nausea, and Vomiting in a Frequent Marijuana User

Single Most Likely Diagnosis

  • Cannabinoid Hyperemesis Syndrome (CHS): This condition is characterized by recurrent episodes of severe vomiting, often accompanied by abdominal pain, and is associated with long-term and heavy use of marijuana. The symptoms described, along with the patient's history of frequent marijuana use and normal findings for other causes of gastritis, make CHS a highly plausible diagnosis.

Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): Although gastritis has been ruled out, GERD could still be a cause of the patient's symptoms, especially if the patient experiences worsening of symptoms after eating or at night.
  • Irritable Bowel Syndrome (IBS): This condition can cause abdominal pain, nausea, and changes in bowel habits. While not directly linked to marijuana use, it's a common cause of abdominal symptoms and should be considered.
  • Peptic Ulcer Disease: Despite initial workup showing no gastritis, peptic ulcers can cause similar symptoms and may not always be detected on initial evaluation.

Do Not Miss Diagnoses

  • Appendicitis: Although less likely given the recurring nature of the symptoms, appendicitis can present with abdominal pain and nausea. Missing this diagnosis could lead to severe consequences, including perforation.
  • Intestinal Obstruction: This is a medical emergency that can cause severe abdominal pain, nausea, and vomiting. It's crucial to rule out obstruction, especially if the patient's symptoms worsen or if there are signs of bowel obstruction on imaging.
  • Pancreatitis: Both acute and chronic pancreatitis can cause severe abdominal pain, nausea, and vomiting. Given the potential for marijuana use to affect the pancreas, this diagnosis should not be overlooked.

Rare Diagnoses

  • Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis): While less common, these conditions can cause chronic abdominal pain, nausea, and changes in bowel habits. They are important to consider, especially if other diagnoses are ruled out.
  • Gastroparesis: This condition, characterized by delayed stomach emptying, can cause nausea, vomiting, and abdominal pain. It might be considered if other causes are excluded, especially in the context of long-term marijuana use, which can affect gastrointestinal motility.

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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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