Differential Diagnosis for Upper GI Bleed
The following is a differential diagnosis for upper GI bleed, categorized for clarity and emphasis on key differentiating features.
Single Most Likely Diagnosis
- Peptic ulcer disease (PUD): This is the most common cause of upper GI bleeding, accounting for approximately 50% of cases. The key differentiating feature is the presence of ulcers in the stomach or duodenum, often associated with Helicobacter pylori infection or NSAID use.
Other Likely Diagnoses
- Gastroesophageal varices: These are dilated veins in the esophagus, often a complication of liver cirrhosis. Differentiating features include a history of liver disease, signs of portal hypertension, and the presence of varices on endoscopy.
- Mallory-Weiss syndrome: This condition involves tears in the mucous membrane or lining of the lower end of the esophagus, where it connects to the stomach. Key features are a history of intense or prolonged vomiting, retching, or coughing before the onset of bleeding.
- Erosive gastritis: This condition involves inflammation of the stomach lining, leading to erosions and potential bleeding. Differentiating features include recent NSAID use, stress, or alcohol consumption.
Do Not Miss Diagnoses
- Aorticenteric fistula: Although rare, this condition (an abnormal connection between the aorta and the intestine) can cause catastrophic bleeding and is often fatal if not promptly diagnosed and treated. Key features include a history of aortic surgery or disease.
- Dieulafoy's lesion: A rare cause of upper GI bleeding, characterized by a small, superficial ulceration with an exposed, often large, caliber artery at its base. The differentiating feature is the presence of this specific type of lesion on endoscopy.
- Hemobilia: Bleeding from the biliary tree into the gastrointestinal tract, which can be due to trauma, tumors, or vascular malformations. Differentiating features include a history of biliary disease or procedures and the presence of blood in the bile ducts.
Rare Diagnoses
- Gastric cancer: Although a less common cause of upper GI bleeding compared to peptic ulcers, gastric cancer can present with bleeding, especially in older adults or those with a family history of the disease. Key features include weight loss, abdominal pain, and a mass on imaging studies.
- Vascular malformations (e.g., angiodysplasia): These are abnormal formations of blood vessels that can cause bleeding. Differentiating features include a history of similar bleeding episodes and the presence of these malformations on endoscopy or imaging.
- Ingested foreign body: Rarely, the ingestion of a foreign body can cause upper GI bleeding, especially if the object is sharp or causes significant mucosal damage. The key feature is a history of foreign body ingestion.