Differential Diagnosis for 78-year-old Female with Vomiting after Meals
Single Most Likely Diagnosis
- Gastroparesis: This condition is characterized by delayed stomach emptying, which can cause vomiting of undigested food, abdominal cramps, loss of appetite, and weight loss. The symptoms described, especially vomiting 5-30 minutes after meals, are classic for gastroparesis.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): While GERD typically presents with heartburn and regurgitation, some patients may experience vomiting after meals, especially if there is significant esophageal dysmotility or a large hiatal hernia.
- Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause vomiting after meals, abdominal pain, and weight loss, especially if the ulcers are large or bleeding.
- Functional Dyspepsia: This condition is characterized by recurrent upper abdominal pain or discomfort, which can be accompanied by vomiting, bloating, and weight loss.
Do Not Miss Diagnoses
- Malignancy (e.g., Gastric Cancer): Although less likely, it is crucial to rule out gastric cancer, especially in an elderly patient with significant weight loss and vomiting. Other malignancies, such as pancreatic cancer, can also cause similar symptoms.
- Mesenteric Ischemia: This condition, which involves insufficient blood flow to the intestines, can cause severe abdominal pain, vomiting, and weight loss. It is a medical emergency that requires prompt diagnosis and treatment.
- Intestinal Obstruction: A mechanical obstruction of the intestine can cause vomiting, abdominal pain, and weight loss. This condition can be life-threatening if not promptly diagnosed and treated.
Rare Diagnoses
- Rumination Syndrome: A condition where food is regurgitated and then chewed and swallowed again, often due to an abnormal contraction of the muscles in the esophagus.
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, which can cause vomiting, abdominal pain, and weight loss.
- Scleroderma: A chronic autoimmune disease that can cause gastrointestinal symptoms, including vomiting, due to esophageal dysmotility and gastroparesis.