Presenting Complaints

• 18-year-old female patient presents with 2 days of nausea, vomiting, and abdominal pain.

History of Presenting Complaint

• The patient reports that 2 days ago, she developed sudden onset of nausea, vomiting, and diffuse abdominal pain.
• The vomiting is non-bilious and occurs 3-4 times per day. She is unable to keep down any solid foods or liquids.
• The abdominal pain is cramping in nature, located in the lower abdomen, and is worse with eating.
• She denies any fever, chills, diarrhea, or recent travel.
• She reports no sick contacts and no recent changes in her diet.

Significant Positives & Negatives For Differentials

Gastroenteritis (viral or bacterial)

Positives:

• Sudden onset of nausea, vomiting, and abdominal pain
• Lack of fever, chills, or diarrhea
• No recent travel, antibiotic use, or sick contacts

Negatives:

• Persistent vomiting and inability to tolerate oral intake
• Severe or localized abdominal pain

Food Poisoning

Positives:

• Sudden onset of gastrointestinal symptoms
• No recent travel or sick contacts

Negatives:

• Lack of fever, chills, or diarrhea
• Persistent vomiting and inability to tolerate oral intake

Appendicitis

Positives:

• Localized right lower quadrant abdominal pain
• Nausea and vomiting

Negatives:

• Diffuse abdominal pain rather than localized
• Lack of fever or leukocytosis

Small Bowel Obstruction

Positives:

• Persistent vomiting and inability to tolerate oral intake
• Diffuse abdominal pain

Negatives:

• Lack of prior abdominal surgeries or hernias
• Absence of bilious vomiting

Gastroparesis

Positives:

• Persistent nausea and vomiting
• Lack of fever or diarrhea

Negatives:

• Acute onset of symptoms rather than chronic
• No known history of diabetes or other conditions associated with gastroparesis

Past Medical History

• No significant past medical history
• No prior hospitalizations or surgeries

Drug/Medication History

• No regular medications
• Denies any recent antibiotic use

Social History

• Lives at home with parents in China
• Attends high school, no significant stressors
• Denies alcohol, tobacco, or recreational drug use

Family History

• No family history of gastrointestinal disorders

Systems Review

• Positive for nausea, vomiting, abdominal pain
• Negative for fever, chills, diarrhea, constipation, blood in stool
• Negative for headache, dizziness, rash

Ideas, Concerns & Expectations

• Patient is concerned she may have food poisoning or a stomach bug
• She expects to receive treatment to help with her symptoms

Case Presentation

Based on the patient's presentation and the key positives and negatives for the differential diagnoses, the most likely diagnosis is acute gastroenteritis. The sudden onset of nausea, vomiting, and abdominal pain without concerning associated symptoms like fever, chills, or diarrhea, along with the lack of recent travel, antibiotic use, or sick contacts, make gastroenteritis the most likely etiology. While other diagnoses like appendicitis or small bowel obstruction should be considered, the overall clinical picture is most consistent with a viral or bacterial gastroenteritis.