Welcome to the very first edition of 2025—let’s kick off the year with a fresh approach!

Case #1:
A 45-year-old female presents with 2-3 days of nausea, vomiting, diffuse abdominal cramping, and three episodes of watery diarrhea. Her whole family has been sick with similar, but she has not gotten better. Her medical history includes a remote appendectomy and denies recent travel, medication use, or significant dietary changes. On exam, she is actively vomiting, looks dehydrated and her abdomen is mildly distended with diffuse tenderness.

Case #2:
A 28-year-old male presents with 2 days of nausea, vomiting, mild abdominal pain, and watery diarrhea. He reports fatigue, unintentional weight loss over the past week, and a headache. On exam, he appears dehydrated, is tachycardic and tachypneic with dry mucous membranes, mild abdominal tenderness

Case #4:
A 1-year-old female presents with 2 days of fever, vomiting, decreased feeding, and intermittent abdominal discomfort. Her sister recently recovered from a upper respiratory tract infection but the patient does not have a cough or runny nose. Her parents note increased fussiness and lethargy and decreased urination. On exam, she looks well, is afebrile with mild abdominal tenderness but no other focal findings

Case #5:
A 30-year-old female presents with 3 days of nausea, vomiting, diarrhea, and abdominal
cramping. She reports unintentional weight loss and increased palpitations over the past month which she attributed to anxiety. On exam, she is tachycardic with warm, moist skin, slightly restless and otherwise unremarkable exam

Case #6:
A 28-year-old male presents with 3 days of nausea, vomiting, diarrhea, and abdominal pain, initially suspected to be gastroenteritis. He reports fatigue, muscle cramps and unintentional weight loss over the past month. On exam, he appears dehydrated, with low blood pressure and has diffuse, nonspecific abdominal tenderness

Take Home Points

• While most acute GI complaints will turn out to be benign conditions, remaining alert to subtle clinical cues can make all the difference in identifying serious conditions early

• Dig deeper when the clinical picture includes persistent symptoms, systemic clues, or red flags/ atypical features.

• A thorough history and attention to subtle exam findings remain your best tools in uncovering the real diagnosis.

• In uncertain cases, don’t hesitate to order targeted investigations to confirm or rule out alternative diagnoses.

References

American College of Emergency Physicians. “Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients with Suspected Gastroenteritis.” ACEP, www.acep.org. Accessed 7 Jan. 2025.

Fauci, Anthony S., et al. Harrison’s Principles of Internal Medicine. 20th ed., McGraw-Hill Education, 2018.

Kliegman, Robert M., et al. Nelson Textbook of Pediatrics. 21st ed., Elsevier, 2020.

Ma, O. John, et al. Diagnostic and Statistical Manual of Emergency Medicine. McGraw-Hill Education, 2019.

Tome, June, et al. “A Practical 5-Step Approach to Nausea and Vomiting.” Mayo Clinic Proceedings, vol. 97, no. 1, 2022, pp. 1-10. Mayo Clinic Proceedings, doi:10.1016/j.mayocp.2021.11.002.

UpToDate. “Clinical Manifestations and Diagnosis of Gastroenteritis in Adults.” Edited by Robert M. Wachter, Wolters Kluwer, www.uptodate.com. Accessed 7 Jan. 2025.

UpToDate. “Evaluation of Nausea and Vomiting in Adults.” Edited by William L. Hasler, Wolters Kluwer, www.uptodate.com. Accessed 7 Jan. 2025.