[28F] With abdominal pain, nausea, vomiting, and headaches

Patient Description

A 28-year-old female presents with sudden onset of abdominal pain located above the belly button, which has been ongoing for 4 days. The pain worsens after eating and is rated as a 7 out of 10 in intensity. The patient reports associated symptoms of constipation, nausea, and vomiting. Vomiting occurs about 3 times a day, increasing to almost 5 times today, and is mostly clear. The patient finds some relief from burping or vomiting. Additionally, the patient experiences throbbing headaches rated as a 4 out of 10, located in the forehead and behind the eyes, which are exacerbated by nausea and alleviated by lying down. The patient also reports feeling very tired and experiencing heartburn, bloating, and a feeling of fullness. There have been no changes in diet, recent travel, or consumption of spicy, fatty, or acidic foods. The patient has a medical history of fibroids (3 cm) and ovarian cysts. No known drug allergies. No recent weight loss or loss of appetite prior to the onset of symptoms.

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Arora's Assessment

What might be happening

Based on the information you have provided, a possible unifying diagnosis is:

  • Gastroesophageal Reflux Disease (GERD): GERD occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. Symptoms often include a burning sensation in your chest (heartburn), usually after eating, which might be worse at night, and regurgitation of food or sour liquid. Your symptoms of nausea, vomiting, and a starving feeling that worsens after eating, along with heartburn and an acid taste in your mouth, are consistent with GERD.

    • Treatment: GERD is typically managed with lifestyle changes, over-the-counter medications like antacids, H2 blockers, or proton pump inhibitors. In some cases, prescription medications or surgery may be necessary.
  • Gastritis: Gastritis is inflammation of the stomach lining. It can be caused by infection, regular use of certain pain relievers, or drinking too much alcohol. Symptoms include a gnawing or burning ache or pain (indigestion) in your upper abdomen that may become either worse or better with eating, nausea, vomiting, and a feeling of fullness in your upper abdomen after eating.

    • Treatment: Treatment for gastritis usually involves medications to reduce stomach acid, such as antacids, H2 blockers, or proton pump inhibitors. Avoiding irritants like NSAIDs, alcohol, and spicy foods can also help.
  • Peptic Ulcer Disease (PUD): Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain. Your symptoms of a starving feeling, pain that worsens after eating, nausea, and vomiting could be indicative of PUD.

    • Treatment: Treatment typically involves medications to reduce stomach acid and antibiotics if an infection is present. Lifestyle changes, such as avoiding NSAIDs, alcohol, and smoking, are also recommended.

What you can do

While it's important to consult a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Dietary Changes: Avoid foods and drinks that can trigger reflux, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine. Eating smaller, more frequent meals can also help.
  2. Stay Upright After Eating: Avoid lying down for at least two to three hours after eating to prevent acid reflux.
  3. Elevate Your Head While Sleeping: Raise the head of your bed by about 6 to 8 inches to help prevent acid from flowing back into your esophagus while you sleep.
  4. Hydration: Drink plenty of water throughout the day to stay hydrated, especially if you are experiencing vomiting.
  5. Over-the-Counter Medications: Consider using antacids or other over-the-counter medications to help neutralize stomach acid and provide relief.
  6. Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your provider. This can help your healthcare provider better understand your condition and tailor your treatment plan.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Severe or persistent abdominal pain
  • Vomiting blood or material that looks like coffee grounds
  • Black, tarry, or bloody stools
  • Unexplained weight loss
  • Difficulty swallowing or pain when swallowing
  • Persistent nausea or vomiting that doesn't improve

Remember, while these suggestions can help manage your symptoms, it's important to consult a healthcare professional for a formal diagnosis and appropriate treatment.

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5 mo ago


People Also Ask


What are the common symptoms of GERD and how can it be managed?

Common symptoms of GERD include heartburn, regurgitation of food or sour liquid, and difficulty swallowing. It can be managed with lifestyle changes such as avoiding trigger foods, eating smaller meals, and staying upright after eating. Over-the-counter medications like antacids, H2 blockers, or proton pump inhibitors can also help.


How does gastritis differ from GERD, and what are its typical treatments?

Gastritis is inflammation of the stomach lining and can cause symptoms like a gnawing or burning ache in the upper abdomen, nausea, and a feeling of fullness. It differs from GERD in that it is more related to inflammation rather than acid reflux. Treatment usually involves medications to reduce stomach acid and avoiding irritants like NSAIDs and alcohol.


What are the signs of peptic ulcer disease and how is it treated?

Signs of peptic ulcer disease include stomach pain, a starving feeling, pain that worsens after eating, nausea, and vomiting. Treatment typically involves medications to reduce stomach acid and antibiotics if an infection is present. Lifestyle changes, such as avoiding NSAIDs, alcohol, and smoking, are also recommended.


When should someone with abdominal pain and nausea seek urgent medical attention?

Urgent medical attention should be sought if there is severe or persistent abdominal pain, vomiting blood or material that looks like coffee grounds, black, tarry, or bloody stools, unexplained weight loss, difficulty swallowing, or persistent nausea or vomiting that doesn't improve.


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