Differential Diagnosis for Chronic Cyclical Emesis in a Young Male with RUQ Tenderness and Marijuana Smoking
Single Most Likely Diagnosis
- Cannabinoid Hyperemesis Syndrome (CHS): This condition is characterized by recurrent episodes of severe vomiting, often accompanied by abdominal pain, and is closely associated with long-term marijuana use. The cyclical nature of the emesis and the patient's history of marijuana smoking make CHS a highly plausible diagnosis.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Chronic vomiting can be a symptom of GERD, and the condition is common enough to be considered in the differential diagnosis, especially if the patient experiences heartburn or regurgitation.
- Peptic Ulcer Disease: The presence of RUQ tenderness could suggest peptic ulcer disease, which can cause chronic or intermittent vomiting, especially if the ulcers are located in the duodenum.
- Functional Dyspepsia: This condition involves recurring signs and symptoms of indigestion that have no obvious cause, which could include nausea and vomiting, although it might not fully explain the cyclical pattern.
Do Not Miss Diagnoses
- Appendicitis: Although less likely given the chronic nature of the symptoms, appendicitis can sometimes present with intermittent or recurring abdominal pain and vomiting. Missing this diagnosis could lead to severe consequences, including perforation.
- Intestinal Obstruction: Any condition causing a mechanical obstruction of the intestines could lead to severe vomiting and abdominal pain. Early diagnosis is crucial to prevent complications like ischemia or perforation.
- Pancreatitis: Both acute and chronic pancreatitis can cause severe abdominal pain and vomiting. Given the potential for serious complications, including pancreatic necrosis or pseudocyst formation, pancreatitis must be considered.
Rare Diagnoses
- Cyclic Vomiting Syndrome (CVS): This is a rare condition characterized by episodes of severe vomiting that are separated by periods of normal health. While it shares some similarities with CHS, it is not associated with marijuana use and is generally considered when other causes have been ruled out.
- Gastric Outlet Obstruction: Conditions like pyloric stenosis or tumors obstructing the gastric outlet can cause vomiting but are less common and would typically present with additional symptoms like significant weight loss or earlier satiety.