Differential Diagnosis for Intractable Nausea and Vomiting
Single Most Likely Diagnosis
- Gastroenteritis: This is often the most common cause of intractable nausea and vomiting, typically resulting from a viral or bacterial infection that inflames the stomach and intestines, leading to symptoms like diarrhea, abdominal cramps, and persistent vomiting.
Other Likely Diagnoses
- Pregnancy: Morning sickness is a common symptom in early pregnancy, which can sometimes be severe enough to be classified as intractable nausea and vomiting, known as hyperemesis gravidarum.
- Gastroesophageal Reflux Disease (GERD): While more commonly associated with heartburn, severe cases of GERD can lead to nausea and vomiting, especially after eating.
- Food Poisoning: Consuming contaminated food can lead to severe and persistent vomiting, often accompanied by diarrhea and abdominal pain.
- Medication Side Effects: Certain medications, such as chemotherapy drugs, antibiotics, and anesthetics, can cause intractable nausea and vomiting as a side effect.
Do Not Miss Diagnoses
- Appendicitis: Although abdominal pain is the hallmark symptom, some patients, especially children and the elderly, may present with nausea and vomiting as primary symptoms, making it crucial not to miss this diagnosis due to its potential for severe complications if untreated.
- Intestinal Obstruction: This condition, where part of the intestine is blocked, can lead to severe vomiting, which may be intractable, and requires immediate medical attention to prevent serious complications.
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain, nausea, and vomiting, which can be intractable and is a medical emergency.
- Brain Tumors: Certain tumors, especially those in the brainstem or cerebellum, can increase intracranial pressure, leading to symptoms like persistent nausea and vomiting.
Rare Diagnoses
- Cyclic Vomiting Syndrome: A rare condition characterized by recurring episodes of severe vomiting, often with no apparent cause, which can be intractable during episodes.
- Gastroparesis: A condition where the stomach takes too long to empty its contents, leading to nausea, vomiting, and feeling full after eating only a small amount of food.
- ** Superior Mesenteric Artery Syndrome**: A rare condition where the duodenum (the first part of the small intestine) is compressed between the abdominal aorta and the superior mesenteric artery, leading to nausea, vomiting, and abdominal pain.
- Increased Intracranial Pressure (ICP): Conditions that increase pressure inside the skull, such as a head injury or stroke, can cause persistent nausea and vomiting among other symptoms.