Differential Diagnosis for Itching in Bilateral Feet Post-Drinking Alcohol in a Patient with Bariatric RNY Surgery

• Single Most Likely Diagnosis
  • Nutritional Deficiency (e.g., Vitamin B12, Iron, or Zinc deficiency): Patients who have undergone bariatric surgery, such as Roux-en-Y (RNY), are at risk for nutritional deficiencies due to malabsorption. These deficiencies can cause a range of symptoms, including itching. Alcohol consumption may exacerbate the symptoms or interact with the deficient state, leading to increased itching sensation.
• Other Likely Diagnoses
  • Liver Disease: Alcohol consumption can lead to liver disease, and liver dysfunction is known to cause itching (pruritus). Although the patient's bariatric surgery might not directly cause liver disease, the combination of alcohol use and potential metabolic changes post-surgery could contribute to liver issues.
  • Gastrointestinal Issues: Post-bariatric surgery patients can experience various gastrointestinal symptoms. While not directly related to alcohol consumption, gastrointestinal issues could indirectly contribute to itching if they lead to malabsorption or other systemic effects.
  • Hormonal Changes: Bariatric surgery can lead to significant weight loss and hormonal changes. Some hormonal imbalances, such as those affecting thyroid function, can cause itching.
• Do Not Miss Diagnoses
  • Cholestasis: Although less common, cholestasis (bile flow reduction or stoppage) can cause severe itching and can be related to liver disease or other conditions that might be exacerbated by alcohol consumption or affected by bariatric surgery.
  • Pancreatitis: Acute or chronic pancreatitis, potentially triggered by alcohol or gallstones (which are more common in patients who have undergone bariatric surgery), can cause abdominal pain and other symptoms, including itching due to potential liver or pancreatic dysfunction.
• Rare Diagnoses
  • Porphyria: A group of disorders that can result in itching, among other symptoms, and can be triggered by alcohol consumption. While rare, porphyria is an important consideration in patients with unexplained itching, especially if other symptoms are present.
  • Sarcoidosis: A condition that can cause itching and is associated with various systemic symptoms. It's less directly related to bariatric surgery or alcohol consumption but should be considered in a differential diagnosis for unexplained itching.