A 24-Year-Old Primigravid Woman at 10 Weeks Gestation Comes to the Emergency

A 24-year-old primigravid woman at 10 weeks gestation comes to the emergency department with severe nausea and vomiting.  During the past 3 weeks, the patient has had nausea lasting most of the day with occasional emesis, but over the past day her vomiting has become so severe that she has been unable to keep down any fluids.  Her medical history includes obesity and appendectomy.  Temperature is 36.7 C (98 F) , blood pressure is 90/50 mm Hg, pulse is 116/min, and respirations are 16/min.  The patient is clutching an emesis basin, into which she frequently spits.  On physical examination, mucous membranes are dry and skin turgor is decreased.  Heart and breath sounds are normal, and the abdomen is soft and nontender.  Transvaginal ultrasound shows a viable, intrauterine twin pregnancy.  She is admitted to the hospital for intravenous fluids and antiemetics.  Although her emesis subsides, 4 hours later she reports worsening chest discomfort that radiates to her back.  Blood pressure is 102/66 mm Hg, and pulse is 112/min.  Breath sounds are equal, and a retrosternal crunching sound is heard with each heartbeat.  The abdomen is soft but mildly tender in the epigastrium.  Which of the following is the most likely diagnosis in this patient?

A) Acute pancreatitis
B) Aspiration pneumonitis
C) Biliary colic
D) Esophageal perforation
E) Mallory-Weiss syndrome
F) Reflux esophagitis

Correct Answer:

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