Differential Diagnosis for Abdominal Pain while Vomiting

When considering abdominal pain accompanied by vomiting, it's crucial to approach the diagnosis systematically to ensure that no critical conditions are overlooked. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Gastroenteritis: This is often the most common cause of abdominal pain and vomiting, typically resulting from a viral or bacterial infection. The symptoms can range from mild to severe and usually resolve on their own within a few days.

• Other Likely Diagnoses

  • Food Poisoning: Similar to gastroenteritis, food poisoning can cause abdominal pain and vomiting, often due to consuming contaminated food or drinks.
  • Viral Gastroenteritis (including Norovirus and Rotavirus): These viruses are highly contagious and can cause severe vomiting and abdominal pain.
  • Gastritis: Inflammation of the stomach lining can lead to abdominal pain and vomiting, often triggered by NSAIDs, alcohol, or stress.
  • Appendicitis: Although more commonly associated with pain that migrates to the lower right abdomen, appendicitis can sometimes present with vomiting and more generalized abdominal pain.

• Do Not Miss Diagnoses

  • Intestinal Obstruction: A blockage in the intestine can cause severe abdominal pain and vomiting. This condition requires immediate medical attention.
  • Perforated Viscus: A hole in the wall of the stomach or intestine can lead to peritonitis, a life-threatening condition characterized by severe abdominal pain and vomiting.
  • Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that radiates to the back, often accompanied by vomiting.
  • Ectopic Pregnancy: In women of childbearing age, an ectopic pregnancy can cause abdominal pain and vomiting, and is a medical emergency.

• Rare Diagnoses

  • Porphyria: A group of disorders that can cause abdominal pain, vomiting, and neurological symptoms.
  • Lead Poisoning: Can cause abdominal pain, vomiting, and constipation among other symptoms.
  • Addisonian Crisis: A life-threatening condition due to adrenal insufficiency, which can present with abdominal pain, vomiting, and hypotension.
  • Superior Mesenteric Artery Syndrome: A rare condition where the duodenum is compressed between the abdominal aorta and the superior mesenteric artery, leading to abdominal pain and vomiting.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough medical history, physical examination, and sometimes diagnostic tests are necessary to determine the underlying cause of abdominal pain and vomiting.