[29F] With severe vomiting and abdominal pain

Patient Description

A 29-year-old female has been experiencing severe vomiting since May, which became unbearable recently. She is unable to keep any food or fluids down, including water, and has lost 35 pounds. She reports possible bloody emesis and fat inflammation below the abdominal wall. Stomach pain began recently, described as sharp, with intensity ranging from 6 to 9 out of 10, and is constant. Diarrhea, which is watery, follows a period of severe constipation. She hasn't eaten since Sunday due to inability to keep anything down. Rebound pain is noted on the lower right side, but a CT scan showed a normal appendix. She experiences lightheadedness, especially when standing, and her urine is dark yellow to almost brown. Pelvic pain with urination is present, but urinalysis is normal. A pelvic ultrasound showed no abnormalities. She has a history of IBS-C diagnosed in adolescence and is allergic to oxycodone. Current medications include Prilosec 40 mg BID and Valium 5 mg at night. Various anti-nausea medications have been tried, with worsening symptoms from an anti-nausea patch.

Arora's Assessment

What might be happening

Based on your symptoms, there are a few possibilities to consider:

Severe Dehydration: Since you can't keep any fluids down, dehydration is a serious concern. This can cause dizziness, dark urine, and weakness.
Gastrointestinal Obstruction or Severe Inflammation: The sharp pain, vomiting, and inability to keep anything down could indicate a blockage or severe inflammation in your digestive tract.
Gastroenteritis or Infection: Although your tests showed a normal appendix, infections can still cause severe symptoms like vomiting and diarrhea.
Peptic Ulcer or Gastritis: The history of black vomit could suggest bleeding in the stomach, possibly from an ulcer.

It's crucial to follow up with your healthcare provider for further evaluation and testing, such as blood tests or imaging, to determine the exact cause.

What you can do

Seek Immediate Medical Attention: Given the severity of your symptoms, it's important to return to the hospital or contact your healthcare provider immediately. You may need IV fluids and further evaluation.
Avoid Eating or Drinking: Until you receive medical advice, avoid trying to eat or drink, as this may worsen your symptoms.
Monitor Symptoms: Keep track of any changes, especially if you notice increased pain, new symptoms, or worsening dizziness.
Emergency Care: If you feel extremely weak, confused, or if your symptoms worsen, consider calling 911 or having someone take you to the emergency room.

Please remember, this information is not a substitute for professional medical advice. It's important to consult with a healthcare provider for a proper diagnosis and treatment.

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4 mo ago

[29F] With severe vomiting and abdominal pain

What might be happening

What you can do

Experiencing symptoms?