Differential Diagnosis for Post-ERCP Vomiting
Single Most Likely Diagnosis
- Post-procedure nausea and vomiting: This is a common side effect of general anesthesia (GA) and the ERCP procedure itself. The normal lipase level suggests that pancreatitis, a known complication of ERCP, is less likely, making post-procedure nausea a more probable cause.
Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD) exacerbation: The procedure might have caused temporary irritation or disruption to the upper GI tract, leading to reflux and vomiting.
- Iatrogenic causes (e.g., medication side effects): Medications used during or after the procedure could be causing vomiting.
- Transient gastric or intestinal irritation: The ERCP procedure might have caused mechanical irritation to the stomach or intestines, leading to vomiting.
Do Not Miss Diagnoses
- Pancreatitis: Although the lipase level is normal, pancreatitis can sometimes present with normal or mildly elevated pancreatic enzymes early in the course. It's crucial to monitor the patient closely and consider repeating the lipase level or other diagnostic tests if clinical suspicion remains high.
- Cholangitis or other biliary complications: Infection or obstruction of the biliary system could occur post-ERCP, presenting with vomiting among other symptoms.
- Perforation: A rare but serious complication of ERCP, which could present with vomiting, abdominal pain, and other signs of peritonitis.
Rare Diagnoses
- Hemorrhagic pancreatitis or pseudoaneurysm: Although rare, these complications could present with non-specific symptoms like vomiting initially.
- Aspiration pneumonia: If the patient aspirated during the procedure, it could lead to pneumonia, presenting with vomiting, fever, and respiratory symptoms.
- Other rare complications of ERCP: Such as duodenal perforation, which might not be immediately apparent but could lead to severe consequences if not recognized and treated promptly.