Differential Diagnosis for Recurrent Nausea, Vomiting, Elevated LFTs, and Lymphadenopathy

Single Most Likely Diagnosis

• Viral Hepatitis: This is a common cause of elevated liver enzymes (LFTs) and can be associated with nausea, vomiting, and lymphadenopathy. The presence of lymphadenopathy might suggest a systemic infection such as hepatitis B or C, which can cause these symptoms.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): While GERD primarily causes heartburn and regurgitation, severe cases can lead to nausea and vomiting. Elevated LFTs can sometimes be seen due to medication side effects or secondary to decreased blood flow to the liver.
• Peptic Ulcer Disease: Similar to GERD, peptic ulcers can cause nausea and vomiting. Lymphadenopathy might be seen in cases of Helicobacter pylori infection, which is a common cause of peptic ulcers.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause nausea, vomiting, and elevated LFTs due to liver involvement (e.g., primary sclerosing cholangitis). Lymphadenopathy can occur due to the systemic nature of the disease.

Do Not Miss Diagnoses

• Lymphoma: Although less common, lymphoma can present with lymphadenopathy, nausea, vomiting, and elevated LFTs due to liver involvement. Missing this diagnosis could be fatal, hence it's crucial to consider it.
• Hepatocellular Carcinoma: In patients with risk factors for liver cancer (e.g., chronic hepatitis B or C, cirrhosis), hepatocellular carcinoma could present with these symptoms. Early detection is key to treatment.
• Wilson's Disease: An autosomal recessive disorder leading to copper accumulation in the liver, which can cause liver dysfunction, nausea, vomiting, and sometimes lymphadenopathy. It's rare but treatable if diagnosed early.

Rare Diagnoses

• Autoimmune Hepatitis: A rare condition where the body's immune system attacks liver cells, leading to elevated LFTs. It can present with nausea, vomiting, and sometimes lymphadenopathy.
• Primary Biliary Cholangitis (PBC): A chronic liver disease characterized by progressive destruction of the bile ducts within the liver, leading to elevated LFTs. It's more common in women and can have systemic symptoms including nausea and vomiting.
• Sarcoidosis: A systemic granulomatous disease that can affect any organ, including the liver and lymph nodes, leading to elevated LFTs and lymphadenopathy. It's a diagnosis of exclusion and can present with a wide range of symptoms including nausea and vomiting.