Question

A 55-year-old man presents to the emergency department with nausea and vomiting. The patient states that he has felt nauseous for the past week and began vomiting last night. He thought his symptoms would resolve but decided to come in when his symptoms worsened. He feels that his symptoms are exacerbated with large fatty meals and when he drinks alcohol. His wife recently returned from a cruise with symptoms of vomiting and diarrhea. The patient has a past medical history of poorly managed diabetes, constipation, anxiety, dyslipidemia, and hypertension. His temperature is 99.5°F (37.5°C), blood pressure is 197/128 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 95% on room air. Physical exam reveals a systolic murmur heard loudest along the left upper sternal border. Abdominal exam reveals an obese, tympanitic and distended abdomen with a 3 cm scar in the right lower quadrant. Vascular exam reveals weak pulses in the lower extremities. Which of the following is the most likely diagnosis?

a. Adhesions
b. Enteric nervous system damage
c. Impacted stool
d. Norovirus
e. Twisting of the bowel

Answer 1

The most likely diagnosis for the patient is norovirus, considering the spike in similar cases, his wife's recent illness after a cruise, and his symptoms of nausea and vomiting that worsened with large fatty meals and alcohol. Norovirus is a common viral cause of gastroenteritis, with rapid onset and potential for severe dehydration.

Step-by-step explanation:

Considering the clinical context of a spike in cases of acute gastroenteritis-like symptoms and his wife's recent illness after a cruise, norovirus, a common cause of viral gastroenteritis, is highly suspect. The patient's symptoms of nausea and vomiting exacerbated by large fatty meals and alcohol, along with the history of exposure through his wife, fit the typical presentation of norovirus infection.

Norovirus is known for causing significant outbreaks, especially in closed or crowded environments such as cruise ships, and it often presents with symptoms of abdominal pain, vomiting, and diarrhea without blood, leading to dehydration. Furthermore, norovirus symptoms typically appear within 12 to 48 hours after exposure and could be more severe in individuals with underlying illnesses, such as poorly managed diabetes. The presence of a systolic murmur, obesity, and weak pulses in the lower extremities may reflect comorbid conditions but do not clearly point towards adhesions, enteric nervous system damage, impacted stool, or twisting of the bowel as the primary issue at hand.