Differential Diagnosis
- Single most likely diagnosis
- Hyperemesis gravidarum: This condition is characterized by severe nausea, vomiting, and weight loss during pregnancy, often requiring hospitalization for hydration and management. The patient's symptoms of persistent nausea, nonbloody vomiting, and inability to tolerate oral intake, along with a significant weight loss, are consistent with this diagnosis. The fact that she is at 8 weeks gestation, a common time for hyperemesis gravidarum to peak, further supports this diagnosis.
- Other Likely diagnoses
- Gastroesophageal reflux disease (GERD) exacerbation: Given the patient's history of esophageal reflux, her current symptoms could be an exacerbation of GERD, possibly worsened by the pregnancy.
- Urinary tract infection (UTI): Although not directly indicated by the symptoms provided, UTIs are common in pregnancy and can cause systemic symptoms such as fever, dizziness, and abdominal pain. However, the absence of specific urinary symptoms (e.g., dysuria, frequency) makes this less likely.
- Pregnancy-related gastritis: Similar to GERD, gastritis could cause epigastric pain and vomiting, potentially exacerbated by the hormonal changes of pregnancy.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although the ultrasound confirms an intrauterine gestation, it's crucial to consider ectopic pregnancy in any pregnant woman presenting with abdominal pain and vomiting, as it is a life-threatening condition.
- Appendicitis: Abdominal pain and vomiting can also be symptoms of appendicitis, which requires prompt surgical intervention to prevent perforation and peritonitis.
- Thyroid storm: Although the thyroid is nonenlarged and without palpable masses, and there's no specific mention of thyroid function test abnormalities, thyroid storm is a life-threatening condition that can present with vomiting, tachycardia, and weight loss.
- Rare diagnoses
- Acute pancreatitis: This could cause epigastric pain and vomiting but would typically be associated with more severe abdominal pain and elevated pancreatic enzymes.
- Adrenal insufficiency: Although rare, adrenal insufficiency can cause nausea, vomiting, weight loss, and hypotension, especially in the context of pregnancy, where the demand for cortisol increases.