Differential Diagnosis for a 34-year-old Pregnant Female with Vomiting and Abdominal Pain

• Single most likely diagnosis:
  • Hyperemesis gravidarum: This condition is characterized by severe nausea and vomiting during pregnancy, often leading to dehydration and weight loss. The patient's symptoms of persistent vomiting, inability to keep food and water down, and temporary relief with IV fluids are consistent with this diagnosis. The fact that she is 13 weeks pregnant, a time when hyperemesis gravidarum typically peaks, further supports this diagnosis.
• Other Likely diagnoses:
  • Gastroenteritis: The patient's symptoms of vomiting, abdominal pain, and lack of bowel movement could also be indicative of a gastrointestinal infection. However, the absence of fever and diarrhea makes this less likely.
  • Urinary tract infection (UTI) or pyelonephritis: These conditions can cause abdominal pain and vomiting, especially in pregnant women. A UTI could also lead to dehydration, which might explain the temporary relief with IV fluids.
  • Appendicitis: Although less common in pregnancy, appendicitis can cause abdominal pain, vomiting, and fever. The patient's intermittent abdominal pain and vomiting of blood could be indicative of a more serious condition like appendicitis.
• Do Not Miss diagnoses:
  • Ectopic pregnancy: Although the patient is 13 weeks pregnant, an ectopic pregnancy can still occur and is a life-threatening condition. Severe abdominal pain and vomiting of blood are red flags that necessitate ruling out an ectopic pregnancy.
  • Preeclampsia: This condition can cause severe vomiting, abdominal pain, and dehydration. Although it typically occurs later in pregnancy, it's essential to consider preeclampsia in any pregnant woman with severe symptoms.
  • Intestinal obstruction: This is a rare but life-threatening condition that can cause severe abdominal pain, vomiting, and constipation. The patient's symptoms of abdominal pain and lack of bowel movement warrant consideration of this diagnosis.
• Rare diagnoses:
  • Acute pancreatitis: This condition can cause severe abdominal pain, vomiting, and dehydration. Although rare in pregnancy, it's essential to consider pancreatitis in any patient with severe abdominal pain and vomiting.
  • Hepatitis: Viral hepatitis can cause nausea, vomiting, and abdominal pain. Although less common, hepatitis is a possible diagnosis that should be considered, especially if the patient has a history of liver disease or exposure to hepatitis.