Differential Diagnosis for a G2P1 8-week pregnant 24-year-old female with emesis with blood, cramping, and vaginal spotting
- Single most likely diagnosis
- Threatened abortion: This is the most likely diagnosis given the patient's symptoms of vaginal spotting, cramping, and emesis with blood at 8 weeks of gestation. Threatened abortion is characterized by vaginal bleeding with or without abdominal cramping in a pregnant woman, with the cervix still closed.
- Other Likely diagnoses
- Hyperemesis gravidarum with possible esophageal tear (Mallory-Weiss syndrome): Although hyperemesis gravidarum typically presents with severe nausea and vomiting, it can occasionally lead to more severe complications like esophageal tears, which could explain the blood in the emesis.
- Gastrointestinal issues (e.g., gastritis, peptic ulcer disease): These conditions could cause emesis with blood and are not directly related to the pregnancy but could be exacerbated by it.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although less likely given the gestational age and the presence of some typical early pregnancy symptoms, ectopic pregnancy is a life-threatening condition that must be considered, especially if there's significant abdominal pain or evidence of hemodynamic instability.
- Placenta previa: This condition, characterized by the placenta covering the cervical os, can cause painless vaginal bleeding but could potentially cause cramping and is a critical diagnosis to consider due to its implications for maternal and fetal health.
- Pulmonary embolism: Pregnancy increases the risk of thromboembolic events, and while less directly related to the presenting symptoms, a pulmonary embolism could cause sudden onset of symptoms including potentially vomiting blood if there's associated hematemesis due to acute stress response or other mechanisms.
- Rare diagnoses
- Molar pregnancy: A rare condition where an abnormal fertilization event leads to an abnormal placenta and often presents with early pregnancy bleeding, severe nausea, and vomiting.
- Hepatic rupture or other hepatic issues: Rare in pregnancy but can present with abdominal pain and potentially vomiting, though blood in the emesis would be less common as a primary symptom.