A 14-year-old female presents with persistent vomiting, despite Zofran (Ondansetron) therapy, and a family history of ulcerative colitis and spastic colon (irritable bowel syndrome)?

Differential Diagnosis for 14-year-old Female with Vomiting

• Single most likely diagnosis:
  • Viral gastroenteritis:
    • This diagnosis is likely due to the patient's symptoms of vomiting, decreased appetite, and the fact that she was able to tolerate small amounts of water initially. The yellow liquid vomit could be bile, which is often seen in cases of gastroenteritis when the stomach is empty. The lack of diarrhea, fever, and blood in the vomit or stool also supports this diagnosis.
• Other Likely diagnoses:
  • Food poisoning:
    • Similar to viral gastroenteritis, food poisoning can cause vomiting, decreased appetite, and abdominal discomfort. The patient's visit to her friend's house and eating a snack could be a potential source of food poisoning.
  • Gastritis:
    • Gastritis, or inflammation of the stomach lining, can cause vomiting, especially after eating or drinking. The patient's symptoms of vomiting after taking small sips of water could be indicative of gastritis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Appendicitis:
    • Although the patient does not have the classic symptoms of appendicitis, such as abdominal pain or fever, it is essential to consider this diagnosis due to its potential severity. Appendicitis can present with vomiting, and the patient's family history of spastic colon could be relevant.
  • Intussusception:
    • This is a condition where a part of the intestine telescopes into another part, causing bowel obstruction. It can present with vomiting, abdominal pain, and sometimes blood in the stool. Although the patient denies hematochezia, it is crucial to consider this diagnosis due to its potential for severe complications.
  • Pancreatitis:
    • Pancreatitis can cause vomiting, abdominal pain, and decreased appetite. The patient's family history of ulcerative colitis could be relevant, as there may be an increased risk of pancreatitis in patients with inflammatory bowel disease.
• Rare diagnoses:
  • Cyclic vomiting syndrome:
    • This is a rare condition characterized by recurrent episodes of severe vomiting, often with no apparent cause. The patient's symptoms of persistent vomiting despite treatment with Zofran could be indicative of this condition.
  • Adrenal insufficiency:
    • This is a rare condition where the adrenal glands do not produce enough cortisol. It can cause vomiting, abdominal pain, and decreased appetite. Although the patient does not have other classic symptoms, such as fatigue or weight loss, it is essential to consider this diagnosis due to its potential severity.