Differential Diagnosis for 60-year-old Patient with Inability to Tolerate Solid Food, Vomiting, and Unintentional Weight Loss
- Single Most Likely Diagnosis
- Esophageal stricture or obstruction: Given the patient's history of lung cancer and recent treatment, it is possible that the cancer has metastasized to the esophagus or that the treatment has caused an esophageal stricture, leading to difficulty tolerating solid food and vomiting.
- Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): The patient's history of alcohol use disorder could contribute to the development of GERD, which may cause vomiting and difficulty eating.
- Peptic ulcer disease: Similar to GERD, the patient's history of alcohol use disorder increases the risk of peptic ulcer disease, which could cause vomiting and weight loss.
- Esophagitis: Inflammation of the esophagus, potentially caused by the patient's history of alcohol use or recent lung cancer treatment, could lead to difficulty eating and vomiting.
- Do Not Miss Diagnoses
- Esophageal cancer: Although the patient has a history of lung cancer, it is essential to consider the possibility of a new primary esophageal cancer, especially given the symptoms of difficulty eating and vomiting.
- Gastric cancer: Metastasis from the lung cancer to the stomach or a new primary gastric cancer could cause the patient's symptoms and would be critical to diagnose early.
- Medication-induced esophagitis: If the patient is taking medications such as bisphosphonates, antibiotics, or NSAIDs, these could cause esophagitis, leading to the patient's symptoms.
- Rare Diagnoses
- Achalasia: A rare motility disorder of the esophagus that could cause difficulty eating and vomiting, although it is less likely given the patient's other medical history.
- Eosinophilic esophagitis: An inflammatory condition of the esophagus that could cause difficulty eating and vomiting, although it is relatively rare and more commonly associated with atopic diseases.
- Scleroderma: A rare autoimmune disease that could cause esophageal dysmotility and lead to the patient's symptoms, although it would be unusual given the lack of other systemic symptoms.