Differential Diagnosis for Hematemesis
Single Most Likely Diagnosis
- Alcoholic Gastropathy: Given the patient's history of heavy ethanol (ETOH) use, alcoholic gastropathy is a likely cause of hematemesis. Chronic alcohol consumption can lead to gastric mucosal damage, resulting in bleeding.
Other Likely Diagnoses
- Peptic Ulcer Disease: The patient's history of heavy ETOH use and cocaine use increases the risk of peptic ulcer disease, which can cause hematemesis.
- Cocaine-Induced Gastritis: Cocaine use can lead to gastric mucosal ischemia and bleeding, making it a possible cause of hematemesis in this patient.
- Gastroesophageal Varices: Although the patient is in remission from lymphoma, the history of heavy ETOH use increases the risk of liver disease and subsequent development of gastroesophageal varices, which can cause hematemesis.
Do Not Miss Diagnoses
- Boerhaave's Syndrome: A tear in the esophagus, which can be caused by forceful vomiting or retching, often associated with heavy ETOH use. This condition is life-threatening and requires prompt diagnosis and treatment.
- Mallory-Weiss Syndrome: A tear in the mucous membrane or submucosa of the lower end of the esophagus, often caused by forceful vomiting or retching, which can lead to hematemesis.
- Lymphoma Recurrence: Although the patient is in remission, it is essential to consider the possibility of lymphoma recurrence, which can cause hematemesis due to gastrointestinal involvement.
Rare Diagnoses
- Dieulafoy's Lesion: A rare cause of gastrointestinal bleeding, characterized by a small, superficial ulceration with a large, exposed artery at its base.
- Gastric Antral Vascular Ectasia (GAVE): A rare condition characterized by vascular ectasias in the gastric antrum, which can cause chronic bleeding and hematemesis.
- Kaposi's Sarcoma: A rare tumor that can cause gastrointestinal bleeding, particularly in patients with a history of immunosuppression or lymphoma.