Differential Diagnosis for 43-year-old Female with Difficulty Eating Meat after SADI

• Single most likely diagnosis:
  • Gastroparesis: This condition is characterized by delayed stomach emptying, which can lead to nausea and vomiting after eating, especially solid foods like meat. Given the patient's recent history of Sleeve Adjustable Duodenal Ileal (SADI) surgery, a form of bariatric surgery, gastroparesis is a plausible complication.
• Other Likely diagnoses:
  • Dysphagia: Difficulty swallowing can lead to the sensation of needing to vomit after attempting to eat solid foods. This could be due to various reasons including esophageal stricture, esophagitis, or even a complication from the SADI surgery.
  • Food aversion or psychological factors: The patient's inability to eat meat could be influenced by psychological factors or a conditioned response to eating meat, possibly triggered by the surgery or other unrelated factors.
• Do Not Miss diagnoses:
  • Intestinal obstruction: Although less common, an intestinal obstruction could cause severe vomiting after eating and is a medical emergency. Given the patient's surgical history, this is a critical diagnosis not to miss.
  • Peptic ulcer disease: Ulcers in the stomach or duodenum can cause nausea and vomiting, especially after eating certain foods. This condition requires prompt treatment to prevent complications.
• Rare diagnoses:
  • Rumination syndrome: A condition where food is regurgitated back up into the mouth, which can be mistaken for vomiting. It's less common but could be considered in the differential diagnosis.
  • Eosinophilic esophagitis: An inflammatory condition of the esophagus that can cause difficulty swallowing and vomiting, especially with solid foods. It's less likely but should be considered if other diagnoses are ruled out.