Differential Diagnosis for 79-year-old Female with Vomiting and Rib Pain
- Single most likely diagnosis:
- Gastroesophageal reflux disease (GERD) or viral gastroenteritis: The patient's symptoms of vomiting, feeling something pull in her ribs, and rib pain, especially with a family member also experiencing vomiting, suggest a gastrointestinal infection or inflammation that could lead to musculoskeletal strain or referred pain.
- Other Likely diagnoses:
- Musculoskeletal strain: The act of vomiting can lead to significant strain on the muscles between the ribs and the back, potentially causing pain.
- Pneumonia: Given the patient's age and symptoms of vomiting and back pain, pneumonia could be a consideration, especially if the patient has a fever or other respiratory symptoms.
- Peptic ulcer disease: The patient's vomiting could be related to a peptic ulcer, which might cause referred pain to the back.
- Do Not Miss diagnoses:
- Pulmonary embolism: Although less likely, given the patient's age and presentation with sudden onset of chest or back pain, pulmonary embolism is a critical diagnosis that must be considered due to its high mortality rate if missed.
- Aortic dissection: This is a life-threatening condition that could present with sudden, severe back pain and should be considered, especially in older adults with risk factors for atherosclerosis.
- Myocardial infarction: Chest or back pain associated with vomiting could be a sign of a heart attack, particularly in an elderly patient.
- Rare diagnoses:
- Boerhaave's syndrome: A rare condition where there is a spontaneous rupture of the esophagus, which could present with severe chest or back pain and vomiting after forceful vomiting.
- Spontaneous pneumothorax: Although rare in this context, a spontaneous pneumothorax could cause sudden chest or back pain and should be considered, especially if the patient has underlying lung disease.