Differential Diagnosis for Upper GI Bleeding in a Patient with Hepatitis B
Single Most Likely Diagnosis
- Variceal bleeding: The patient's history of hepatitis B and long-term antiviral treatment with entecavir suggests the possibility of liver cirrhosis, which is a common cause of variceal bleeding. The presence of fresh blood in the upper GI tract is consistent with this diagnosis.
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 consumption, or stress.
- Mallory-Weiss tear: This is a mucosal or submucosal tear at the junction of the stomach and esophagus, often associated with intense or prolonged vomiting, retching, or coughing.
Do Not Miss Diagnoses
- Hepatocellular carcinoma (HCC) with bleeding: Although less likely, HCC is a potential complication of chronic hepatitis B infection, and bleeding from an HCC can present as upper GI bleeding.
- Portal hypertensive gastropathy: This condition is characterized by mucosal changes in the stomach due to portal hypertension and can cause significant bleeding.
- Aortic-enteric fistula: Although rare, this condition can cause catastrophic bleeding and should be considered in patients with a history of aortic surgery or disease.
Rare Diagnoses
- Dieulafoy's lesion: A rare cause of upper GI bleeding, characterized by a small, superficial ulceration with a large, exposed artery at its base.
- Gastrointestinal lymphoma: A rare malignancy that can cause upper GI bleeding, especially in patients with a history of immunosuppression or chronic infection.
- Vascular malformations: Rare congenital or acquired vascular anomalies that can cause upper GI bleeding, such as angiodysplasia or arteriovenous malformations.