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A 70-year-old woman is brought to the emergency department from her nursing home

70 years old | Female

Vignette:

A 70-year-old woman is brought to the emergency department from her nursing home with a history of nausea, projectile vomiting, and nonbloody diarrhea of a 1-day duration. She complains of generalized body aches, chills, and fatigue. Past medical history includes hypertension and coronary artery disease. BP on examination is 100/60 mmHg and heart rate is 110 beats per minute. Abdomen is nondistended and is nontender. Her roommate in the nursing home has also had diarrhea for 2 days.

Summary:

nausea | Projectile vomiting | diarrhea | 1-day duration | generalized body aches | chills | fatigue | hypotension | tachycardia

Dx:

Viral Gastroenteritis Gastroenteritis Bacterial Gastroenteritis Eosinophilic Gastroenteritis Listerial Gastroenteritis Mucosal Eosinophilic Gastroenteritis Subserosal Eosinophilic Gastroenteritis Muscle Layer Eosinophilic Gastroenteritis

Ref:

https://online.epocrates.com/diseases/20222/Viral-gastroenteritis-in-adults/Common-Vignette

Rank

Disease

Weight

1 Non-cholera Vibrio infections 345.0
2 Salmonella infection 316.0
3 Acute Pancreatitis 315.0
4 Crohn Disease 308.0
5 Addison Disease 306.0
6 mucosal Eosinophilic gastroenteritis 305.0
7 Malaria 301.0
8 Spontaneous bacterial peritonitis 279.0
9 Giardiasis 271.0
10 Brucellosis 270.0
11 Diabetic Ketoacidosis 269.0
12 Hereditary Angioedema 266.0
13 Ulcerative Colitis 264.0
14 Bacterial gastroenteritis 260.0
15 Systemic lupus erythematosus 260.0
16 Acute perforated appendicitis 258.0
17 Food poisoning 258.0
18 Klebsiella pneumoniae liver abscess 257.0
19 Viral Gastroenteritis 253.0
20 Mesenteric ischemia 250.0
21 Pyogenic Liver Abscess 250.0
22 Anaphylaxis 247.0
23 Acute peptic ulcer 246.0
24 Intestinal Obstruction 245.0
25 Gastroparesis 243.0
26 Hemolytic uremic syndrome 242.0
27 Listerial gastroenteritis 240.0
28 Muscle Layer Eosinophilic gastroenteritis 240.0
29 Infectious mononucleosis 240.0
30 Pheochromocytoma 239.0
31 pancreatic cancer 237.0
32 Alcoholic Liver Disease 231.0
33 Acute intermittent porphyria 228.0
34 Acute pyelonephritis in adults 228.0
35 Campylobacter infection 225.0
36 Gallstone pancreatitis 224.0
37 Systemic sclerosis 223.0
38 Cholera 221.0
39 Acute viral meningitis 217.0
40 Sarcoidosis 216.0
41 Short bowel syndrome 215.0
42 Acute Appendicitis 213.0
43 Foodborne E coli infection 213.0
44 Toxic Megacolon 210.0
45 Primary biliary cirrhosis 208.0
46 Irritable Bowel Syndrome 205.0
47 Adrenal crisis 204.0
48 Type 1 Diabetes mellitus 203.0
49 Migraine headache in adults 203.0
50 Peritoneal dialysis associated peritonitis 201.0
51 Intra-abdominal abscess 201.0
52 Ovarian and fallopian tube torsion 199.0
53 Acute fatty liver of pregnancy 198.0
54 Intestinal Pseudo Obstruction 193.0
55 Rocky Mountain spotted fever 193.0
56 Graves Disease 192.0
57 Acute Cholecystitis 190.0
58 Emphysematous cholecystitis 190.0
59 Gastric Outlet Obstruction 190.0
60 subserosal eosinophilic gastroenteritis 190.0
61 Acute bacterial meningitis in children 190.0
62 Anthrax 189.0
63 Alcoholic Liver Cirrhosis 188.0
64 Eosinophilic gastroenteritis 186.0
65 Intussusception 185.0
66 Primary sclerosing cholangitis 185.0
67 Lactose intolerance 184.0
68 Chronic bacterial prostatitis 182.0
69 Pneumonia 181.0
70 Liver disease 180.0
71 Ileus 178.0
72 Intestinal Entamoeba histolytica amebiasis 178.0
73 Biliary cirrhosis 177.0
74 Hiatus hernia 173.0
75 Renal and perinephric abscess 172.0
76 Panic disorder in adults 172.0
77 Gastroenteritis 171.0
78 Secondary Peritonitis 169.0
79 Ruptured Tuboovarian abscess 167.0
80 Kawasaki disease 166.0
81 Pyelonephritis 165.0
82 Ovarian Hyperstimulation Syndrome 164.0
83 Non-small cell lung cancer 164.0
84 Aseptic meningitis 164.0
85 Travelers diarrhea 162.0
86 Chronic Pancreatitis 160.0
87 Acute Hepatitis 160.0
88 Hyperthyroidism 157.0
89 Chronic heart failure 157.0
90 Hypercalcemia 156.0
91 Liver Cirrhosis 155.0
92 Non-ST-elevation myocardial infarction 155.0
93 Autoimmune hepatitis 154.0
94 ST-elevation myocardial infarction 153.0
95 Amphetamine use disorder 153.0
96 Endometritis 153.0
97 Choledocholithiasis 152.0
98 Polyarteritis nodosa 151.0
99 Foreign body ingestion 149.0
100 Thrombotic thrombocytopenic purpura 148.0
101 Bacterial pharyngitis 148.0
102 Alcoholic hepatitis 147.0
103 Acute bacterial meningitis in adults 144.0
104 Acute peritonitis 144.0
105 Migraine 143.0
106 Ankylosing spondylitis 143.0
107 Alcoholic Fatty Liver 142.0
108 Celiac Disease 142.0
109 Unstable angina 142.0
110 Diverticulitis 140.0
111 Ovarian Cancer 139.0
112 Acute Liver Failure 137.0
113 Gallbladder cancer 136.0
114 Motion Sickness 136.0
115 Acute Cholangitis 135.0
116 Adrenal Suppression 135.0
117 Pancreatic Pseudocyst 134.0
118 Ovarian Torsion 133.0
119 Papilledema 132.0
120 Sunburn 132.0
121 End Stage Renal Disease 130.0
122 Clostridium difficile infection 130.0
123 Gastritis 128.0
124 Disseminated intravascular coagulation 128.0
125 Duodenal Ulcer 126.0
126 Gastric Ulcer 126.0
127 Abetalipoproteinemia 126.0
128 Acute Mitral regurgitation 126.0
129 Colorectal cancer 125.0
130 Diabetic Amyotrophy 125.0
131 Acute heart failure 124.0
132 Tetanus 124.0
133 Ruptured ectopic pregnancy 123.0
134 Autosomal Dominant Polycystic Kidney Disease 122.0
135 Heparin-induced thrombocytopenia 122.0
136 Type 2 Diabetes mellitus 120.0
137 Obstructive Sleep Apnea 120.0
138 Insect bites and stings 120.0
139 Acromegaly 118.0
140 Henoch-Schonlein purpura 117.0
141 Multiple Sclerosis 117.0
142 Amyloidosis 116.0
143 Gastric cancer 113.0
144 Hyperosmolar Hyperglycemic state 113.0
145 Ischemic stroke 113.0
146 Annular pancreas 112.0
147 Mallory-Weiss syndrome 112.0
148 Gallbladder Dyskinesia 111.0
149 pancreatic SOD 111.0
150 Diabetes Mellitus 111.0
151 Aortic stenosis 110.0
152 Typhoid infection 109.0
153 Meckel diverticulum 109.0
154 Cryptococcosis 109.0
155 Stevens-Johnson syndrome 108.0
156 Inflammatory Bowel Diseases 107.0
157 Rheumatoid Arthritis 107.0
158 Fibromyalgia 107.0
159 Toxic multinodular goiter 107.0
160 Acetaminophen overdose 106.0
161 Mitral Stenosis 105.0
162 Chronic atrial fibrillation 105.0
163 Sigmoid volvulus 104.0
164 Chronic Hepatitis 104.0
165 COVID19 104.0
166 Chronic Myeloid Leukemia 104.0
167 Parkinson disease 104.0
168 Gallstones 103.0
169 Ectopic Pregnancy 103.0
170 Hyperparathyroidism 102.0
171 Diabetic Kidney Disease 102.0
172 Common cutaneous drug reactions 102.0
173 Stable ischemic heart disease 102.0
174 Hemorrhagic stroke 102.0
175 Labyrinthitis 101.0
176 Painless thyroiditis 101.0
177 Milk-alkali syndrome 100.0
178 Acute Milk-alkali syndrome 100.0
179 Chronic Milk-alkali syndrome 100.0
180 Tuberculous Peritonitis 99.0
181 anterior ischemic optic neuropathy 99.0
182 Kidney stones 98.0
183 Acute Lymphoblastic leukemia in children 98.0
184 Osteoarthritis 98.0
185 Hypoparathyroidism 97.0
186 Multiple endocrine neoplasia 2A 97.0
187 Tuboovarian abscess 96.0
188 Abdominal compartment syndrome 96.0
189 Sphincter of Oddi Dysfunction 95.0
190 Acute Clonorchiasis 95.0
191 biliary SOD 95.0
192 Subdural hematoma 95.0
193 Anal Fissure 95.0
194 Sialadenitis 94.0
195 Choledochal Cyst 93.0
196 Churg-Strauss Syndrome 93.0
197 Familial Mediterranean fever 93.0
198 Chronic pelvic pain in women 93.0
199 Prinzmetal angina 91.0
200 Gout 91.0
201 Chronic pyelonephritis 91.0
202 Gastrointestinal Hemorrhage 91.0
203 Lower gastrointestinal hemorrhage 91.0
204 Upper gastrointestinal hemorrhage 91.0
205 Zollinger-Ellison Syndrome 90.0
206 Chronic Mitral regurgitation 90.0
207 Esophagitis 89.0
208 Glomerulonephritis 89.0
209 Acute otitis media 89.0
210 Acute Myeloid Leukemia in adults 89.0
211 Hypothyroidism 88.0
212 Multiple Myeloma 88.0
213 Animal bites 88.0
214 Autoimmune Pancreatitis 87.0
215 Inguinal hernia 87.0
216 Influenza 87.0
217 Wilson disease 86.0
218 Ascites 86.0
219 Acute disseminated encephalomyelitis 86.0
220 Stable angina 86.0
221 Toxic thyroid adenoma 86.0
222 STI HIV Pharyngitis 86.0
223 Premenstrual syndrome 86.0
224 Multiple endocrine neoplasia 2B 85.0
225 Peutz-Jeghers Syndrome 84.0
226 Ischemic optic neuropathy 82.0
227 posteriorischemic optic neuropathy 82.0
228 Hereditary hemochromatosis 81.0
229 Graves ophthalmopathy 81.0
230 Angle Closure Glaucoma 80.0
231 Cushing syndrome 80.0
232 Hypertriglyceridemia 80.0
233 Aortic Dissection 80.0
234 Eclampsia 80.0
235 Acute bacterial rhinosinusitis 79.0
236 Drowning 77.0
237 Chronic fatigue syndrome 76.0
238 Analgesic nephropathy 75.0
239 chronic acalculous cholecystitis 74.0
240 Lung Cancer 74.0
241 Diabetic Neuropathy 74.0
242 Shigellosis 74.0
243 Acute respiratory failure 74.0
244 Acute Bacterial Prostatitis 74.0
245 Meniere disease 73.0
246 Goiter 73.0
247 Diffuse nontoxic goiter 73.0
248 Obstructive cervical goiters 73.0
249 Cervical goiter 73.0
250 COPD Exacerbation 73.0
251 biliary colic 72.0
252 Asthma 72.0
253 Cholangiocarcinoma 71.0
254 Cellulitis 71.0
255 Primary Myelofibrosis 70.0
256 Allergic rhinitis 70.0
257 Non-diabetic hypoglycemia 70.0
258 Acute bacterial meningitis in neonates 69.0
259 Menopause 69.0
260 Dyspepsia 68.0
261 Peritonitis 68.0
262 Acute pericarditis 67.0
263 Hyperprolactinemia 67.0
264 Gilbert syndrome 67.0
265 Extraintestinal Entamoeba histolytica amebiasis 67.0
266 Chronic Kidney Diseases 67.0
267 Fungal meningitis 66.0
268 Acute atrial fibrillation 66.0
269 Adrenocortical carcinoma 65.0
270 Endometrial cancer 65.0
271 Herpes zoster 65.0
272 Chronic Clonorchiasis 64.0
273 Peptic Ulcer 62.0
274 Primary hypogonadism 61.0
275 Secondary hypogonadism 61.0
276 Hyperglycemia 60.0
277 Renal vein thrombosis 60.0
278 Chronic Renal vein thrombosis 60.0
279 Acute Renal vein thrombosis 60.0
280 Rumination Syndrome 59.0
281 Familial adenomatous polyposis syndrome 59.0
282 Amebic Liver Abscess 59.0
283 Acute Lymphocytic Leukemia in Adults 58.0
284 Viral pharyngitis 58.0
285 Autosomal Recessive Polycystic Kidney Disease 57.0
286 Cystic Fibrosis 57.0
287 Granulomatosis with polyangiitis 57.0
288 Non-alcoholic Fatty Liver Disease 57.0
289 Acalculous Cholecystitis 56.0
290 Central hypothyroidism 56.0
291 Achalasia 55.0
292 Gastroesophageal reflux disease 54.0
293 Hepatocellular carcinoma 54.0
294 Hyperaldosteronism 54.0
295 Acute Rhinosinusitis 54.0
296 Acute viral rhinosinusitis 54.0
297 Amebiasis 53.0
298 Intraperitoneal bleeding 53.0
299 Splenic Infarction 51.0
300 Balanitis 51.0
301 Breast Cancer 50.0
302 Primary ciliary dyskinesia 50.0
303 Kartagener syndrome 50.0
304 Pulmonary Embolism 50.0
305 Autoimmune hemolytic anemia 50.0
306 Pharyngitis 50.0
307 Herpes pharyngitis 50.0
308 Insomnia in adults 50.0
309 Guillain-Barre syndrome 47.0
310 Anaplastic thyroid cancer 47.0
311 Stroke 47.0
312 Erectile dysfunction 47.0
313 Osteoporosis 46.0
314 Hypogammaglobulinemia 46.0
315 Osteomyelitis 46.0
316 Malt lymphoma 45.0
317 Periorbital and orbital cellulitis 45.0
318 Pancreatitis 45.0
319 Cholangitis 45.0
320 cholestatic liver disease 45.0
321 Renal Cell Carcinoma 44.0
322 Hepatorenal Syndrome 43.0
323 Medullary thyroid cancer 43.0
324 Intestinal malrotation 42.0
325 Prolactinoma 42.0
326 Angiodysplasia of the colon 41.0
327 Acute Cystitis(Men) 40.0
328 Urinary tract infection 40.0
329 Cystitis 40.0
330 Bullous pemphigoid 40.0
331 Common cold(adults) 39.0
332 Psoriasis 38.0
333 Gallbladder Empyema 37.0
334 Secondary hyperparathyroidism 36.0
335 Laryngeal Cancer 36.0
336 Nephrogenic diabetes insipidus 35.0
337 Central diabetes insipidus 35.0
338 Acute Myeloid Leukemia in children 35.0
339 Intrahepatic cholestasis of pregnancy 34.0
340 Anemia of chronic disease 34.0
341 Abnormal uterine bleeding 34.0
342 Nasal polyps 34.0
343 Oral candidiasis 34.0
344 Vulvovaginal candidiasis 34.0
345 Oropharyngeal and esophageal candidiasis 34.0
346 Candida Balanitis 34.0
347 Candidal intertrigo 34.0
348 Testicular cancer 33.0
349 Leiomyomas 33.0
350 Chronic Lymphocytic Leukemia 33.0
351 Endometriosis 33.0
352 chronic cholestatic liver disease 33.0
353 Varicose veins 33.0
354 Atypical pneumonia 32.0
355 Pelvic inflammatory disease 31.0
356 Acute pelvic inflammatory disease 31.0
357 Systemic vasculitis 31.0
358 Psychogenic polydipsia 30.0
359 Chronic meningitis 30.0
360 Male factor infertility 30.0
361 Umbilical hernia 29.0
362 Miliaria 29.0
363 Urinary Tract Obstruction 28.0
364 Atopic dermatitis 28.0
365 Gastric Volvulus 26.0
366 Bladder Cancer 26.0
367 Aortic coarctation 25.0
368 Alzheimer disease 25.0
369 Epiploic appendagitis 24.0
370 Rotor syndrome 23.0
371 Hepatic Encephalopathy 22.0
372 Psoas Abscess 22.0
373 Clonorchiasis 20.0
374 Epidemic keratoconjunctivitis 20.0
375 Bed bugs 20.0
376 Exocrine pancreatic insufficiency 20.0
377 Empyema 20.0
378 Genital herpes 20.0
379 Charcot-Marie-Tooth Disease 20.0
380 Chronic Cholecystitis 18.0
381 Tinnitus 18.0
382 Pressure ulcer 18.0
383 Renal Artery Stenosis 18.0
384 Croup 18.0
385 Musculoskeletal sprains and strains 18.0
386 Acute cervical spine trauma 18.0
387 Phenylketonuria 18.0
388 Acute Bronchitis 17.0
389 Middle East respiratory syndrome 17.0
390 Pseudohypoparathyroidism 16.0
391 Ruptured ovarian cyst 16.0
392 Bacterial conjunctivitis 15.0
393 Viral conjunctivitis 15.0
394 Paraneoplastic Syndromes 15.0
395 Hemorrhoids 15.0
396 Chlamydia pneumoniae infection 15.0
397 Epididymo-orchitis 15.0
398 Substernal goiter 15.0
399 Dystonia 15.0
400 Common cold(children) 14.0
401 Biliary cyst 14.0
402 Liver Abscess 14.0
403 Rotator Cuff Tears 14.0
404 Acne fulminans 14.0
405 Gingivitis 14.0
406 Mitral Valve Prolapse 14.0
407 Thyroid lymphoma 12.0
408 Von willebrand disease 12.0
409 Chronic liver disease 12.0
410 Portal hypertension 12.0
411 Discogenic low back pain 11.0
412 Premature labor 10.0
413 Budd Chiari Syndrome 9.0
414 Splenic abscess 8.0
415 Psoriatic arthritis 7.0
416 Benign Prostatic Hyperplasia 7.0
417 Ramsay Hunt syndrome 6.0
418 Dacryocystitis 5.0
419 Limited cutaneous systemic sclerosis 5.0
420 Pityriasis rosea 5.0
421 Alopecia areata 2.0
422 Simple kidney cyst 1.0
423 Conjunctivitis 0.0
424 Allergic conjunctivitis 0.0
425 Ligneous conjunctivitis 0.0
426 Vernal keratoconjunctivitis 0.0
427 Atopic keratoconjunctivitis 0.0
428 Noninfectious nonallergic conjunctivitis 0.0
429 Acute epididymitis 0.0
430 Immune thrombocytopenia 0.0
431 Recurrent aphthous stomatitis 0.0
432 Transient ischemic attack 0.0
433 Myasthenia Gravis 0.0
434 Congenital Myasthenic Syndromes 0.0
435 Neonatal Myasthenia Gravis 0.0
436 Acute Cystitis(Women) 0.0
437 Oropharyngeal cancer 0.0
438 Carpal Tunnel Syndrome 0.0
439 Bell palsy 0.0
440 Penis Carcinoma 0.0
441 Optic neuritis 0.0
442 Neuropapillitis 0.0
443 Orthostatic hypotension 0.0
444 Pulmonary regurgitation 0.0