Differential Diagnosis for a 7-week-old Girl with Progressive Vomiting
- Single most likely diagnosis
- Pyloric Stenosis: This condition is characterized by the thickening of the pylorus muscle, leading to gastric outlet obstruction. The symptoms of progressive vomiting, especially after feedings, and the presence of hunger between episodes are classic for pyloric stenosis. The age of the patient also fits, as pyloric stenosis typically presents between 3 to 6 weeks of age.
- Other Likely diagnoses
- Gastroesophageal Reflux Disease (GERD): Although GERD can cause vomiting, it typically does not progress to forceful vomiting as seen in pyloric stenosis. However, it remains a consideration, especially if the vomiting is posited to be related to feedings.
- Infectious Gastroenteritis: Despite the absence of fever or diarrhea, a viral gastroenteritis could still be considered, especially if the vomiting is severe and the patient shows signs of dehydration or electrolyte imbalance.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Intussusception: Although more common in older infants, intussusception can occur at any age and is a surgical emergency. The classic triad of abdominal pain, vomiting, and bloody stools may not always be present, making it a diagnosis that should not be missed.
- Volvolus or Other Surgical Abdominal Emergencies: Conditions like midgut volvulus or intestinal obstruction can present with vomiting and require immediate surgical intervention to prevent serious complications or death.
- Metabolic Disorders: Certain metabolic disorders can present with vomiting, especially if there's an associated metabolic acidosis or abnormal glucose levels. The low glucose level in this patient warrants consideration of a metabolic disorder.
- Rare diagnoses
- Congenital Anomalies of the Gastrointestinal Tract: Conditions such as duodenal atresia, stenosis, or other congenital anomalies could present with vomiting but are less likely given the age of presentation and the specific symptoms.
- Food Protein-Induced Allergic Proctocolitis or Other Allergic Conditions: Although these conditions can cause vomiting, they are less common and typically associated with other symptoms like blood in stool or specific dietary associations.