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Teenager with severe vomiting and pain in the knee. Mother with a positive ANA. Concerned

My 17 year old daughter has a long standing history of periods of vomitting. Lately she has been vomitting more, and started complaining about her knees hurting so bad she prefers not to walk more than she has to. In the last 24 hours she has started vomitting every hour or so. She does not have a fever and the knees may or may not be swollen but are not hot or red. Any ideas? I see a rheumatologist for a positive ANA but she has been checked about a year ago for a positive ANA and did not have one.
Asked On : Thu, 4 Apr 2013
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General Surgeon 's  Response

Thank you for the query.

Joints problems and gastrointestinal problem can both appear with inflammatory bowels disease (Crohns disease). Vomiting can be a result of bowels obstruction. Especially if she does suffer from gas blockage, diarrhea, or diarrhea and constipation alternately. ANA can be elevated in Crohns disease. This is the first thing that should be ruled out (as it seems that this is not gastrointestinal infection). To do that she should have abdominal X-ray and enteroclysis (abdominal CT with oral contrast) should be considered.
The other reasons of severe vomiting can be peptic ulcer, gallstones, pancreatitis, food allergy, brain tumor, internal ear disease.
The next step should be blood work, liver tests, bilirubin, amylase, urine analysis, abdominal ultrasound and endoscopy.
Depending of the results some other tests might be necessary.

Hope this will help.
Answered: Thu, 4 Apr 2013
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