Differential Diagnosis for a 4-Month-Old Boy with Vomiting and Irritability
- Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): This condition is common in infants and can cause vomiting, irritability, and refusal to feed. The green color of the vomitus may indicate bile, suggesting that the vomiting is not solely due to GERD, but the overall clinical picture and the fact that the patient is irritable both before and after vomiting, along with refusal to feed, aligns closely with GERD.
- Other Likely Diagnoses
- Pyloric stenosis: Although the vomitus is occasionally green, which might not typically be seen in pyloric stenosis, this condition should be considered, especially if the vomiting is projectile and the patient shows signs of hunger after vomiting. However, the absence of a palpable "olive" and the variability in vomitus color make this less likely.
- Food protein-induced allergy or intolerance: Given that the patient's symptoms have not improved with formula changes, an allergy or intolerance could be considered, though the green color of the vomitus is less typical for this diagnosis.
- Gastrointestinal obstruction: Although the abdomen is described as soft and nontender, intermittent obstruction could explain the variability in symptoms and the green color of the vomitus, suggesting bile.
- Do Not Miss Diagnoses
- Intussusception: This is a medical emergency that can cause vomiting, irritability, and sometimes currant jelly stool (though the stool is described as normal in this case). It's crucial to consider this diagnosis due to its potential for severe consequences if missed.
- Volvulus or malrotation: These conditions can cause bilious vomiting and are surgical emergencies. The history of an omphalocele, which is associated with malrotation, increases the suspicion for these conditions.
- Hirschsprung's disease: Although typically diagnosed earlier, it could be considered in the differential for chronic constipation or obstruction symptoms, but the presence of normal, brown stool makes this less likely.
- Rare Diagnoses
- Eosinophilic esophagitis or gastroenteritis: These conditions could cause vomiting and irritability but are less common in infants and would typically be considered after more common causes are ruled out.
- Metabolic disorders: Certain metabolic disorders can cause vomiting and irritability in infants. While rare, they are important to consider, especially if the patient does not respond to treatment for more common conditions.