Differential Diagnosis for Alcoholic Patient with Nausea, Vomiting, and Respiratory Symptoms

• Single most likely diagnosis:
  • Mallory-Weiss syndrome: This condition is characterized by tears in the mucous membrane or lining of the lower end of the esophagus, where it connects to the stomach. These tears can lead to bleeding. The symptoms presented, such as nausea, vomiting, and epigastric pain, especially in an alcoholic patient who may have had episodes of intense or prolonged vomiting, make Mallory-Weiss syndrome a plausible diagnosis.
• Other Likely diagnoses:
  • Pneumothorax: The presence of decreased air sounds on one side of the chest, along with tachycardia and dyspnea, suggests a pneumothorax, which is the accumulation of air or gas in the cavity between the lungs and the chest wall, leading to a lung collapse. This could be secondary to the intense vomiting or other traumatic events.
  • Rupture esophagus (Boerhaave's syndrome): Although less common than Mallory-Weiss syndrome, a rupture of the esophagus could occur due to severe vomiting, leading to symptoms like chest pain, difficulty breathing, and potentially decreased air sounds if there's associated pneumothorax or mediastinitis.
• Do Not Miss diagnoses:
  • Rupture trachea: A tracheal rupture is a life-threatening condition that requires immediate diagnosis and treatment. Symptoms can include severe respiratory distress, subcutaneous emphysema, and pneumothorax. Although less likely, missing this diagnosis could be fatal.
• Rare diagnoses:
  • Other rare conditions could include esophageal perforation due to other causes (e.g., iatrogenic, foreign body), pulmonary embolism (though the presentation might be slightly different), or even a spontaneous pneumothorax in the absence of clear trauma or vomiting-induced rupture. These are less directly linked to the symptoms described but should be considered in a broader differential diagnosis, especially if initial diagnoses are ruled out.