Nausea, vomiting, diarrhea, fatigue and abdominal pain

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differentials based on nausea, vomiting, diarrhea, fatigue and abdominal pain

Gastric dumping syndrome should be differentiated from other diseases presenting with nausea, vomiting, diarrhea, fatigue and abdominal pain. The differentials include the following: Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease	Clinical manifestations													Diagnosis		Comments
	Symptoms									Signs
	Abdominal Pain	Fever	Rigors and chills	Nausea or vomiting	Jaundice	Constipation	Diarrhea	Weight loss	GI bleeding	Hypo- tension	Guarding	Rebound Tenderness	Bowel sounds	Lab Findings	Imaging
Chronic pancreatitis	Epigastric	−	−	±	±	−	+	+	−	−	−	−	N	Increased amylase / lipase Increased stool fat content Pancreatic function test	CT scan Calcification Pseudocyst Dilation of main pancreatic duct	Predisposes to pancreatic cancer
Pancreatic carcinoma	Epigastric	−	−	+	+	−	+	+	−	−	−	−	N	↑ Alkaline phosphatase ↑ serum bilirubin ↑ gamma-glutamyl transpeptidase ↑ CA 19-9	MDCT with  PET/CT MRI	Skin manifestations may include: Bullous pemphigoid Cicatricial pemphigoid Migratory superficial thrombophlebitis (classic Trousseau's syndrome) Pancreatic panniculitis
Dumping syndrome	Lower and then diffuse	−	−	+	−	−	+	+	−	+	−	−	Hyperactive	Glucose challenge test Hydrogen breath test	Upper GI series Gastric emptying study	Postgastrectomy