Differential Diagnosis for Upper GI Bleeding
Single Most Likely Diagnosis
- Variceal bleeding: Given the patient's history of hepatitis B, which can lead to cirrhosis, and the presence of upper GI bleeding, variceal bleeding is a highly plausible cause. The use of entecavir for 3 years suggests controlled viral replication, but cirrhosis and its complications can still occur.
Other Likely Diagnoses
- Peptic ulcer disease: This is a common cause of upper GI bleeding and can be related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs), stress, or Helicobacter pylori infection.
- Gastritis: Similar to peptic ulcer disease, gastritis can cause upper GI bleeding and may be related to NSAID use, alcohol, or stress.
- Mallory-Weiss tear: Although less common, this condition, often associated with intense or prolonged vomiting, retching, or coughing, can lead to upper GI bleeding.
Do Not Miss Diagnoses
- Hepatocellular carcinoma (HCC) with bleeding: Although less likely, HCC is a complication of chronic hepatitis B and can cause upper GI bleeding if the tumor erodes into the GI tract.
- Portal hypertensive gastropathy: This condition, associated with cirrhosis and portal hypertension, can cause chronic or acute upper GI bleeding.
- Aortic-enteric fistula: A rare but potentially fatal condition where there's a fistula between the aorta and the GI tract, often seen in patients with previous aortic surgery or infection.
Rare Diagnoses
- 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.
- Gastrointestinal lymphoma: Although rare, lymphoma can cause upper GI bleeding, especially in immunocompromised patients or those with a history of hepatitis B, which may increase the risk of lymphoproliferative disorders.
- Vascular malformations or angiodysplasia: These are rare causes of upper GI bleeding, often seen in older adults or those with chronic diseases.