Differential Diagnosis
- Single most likely diagnosis
- Peptic ulcer disease: The patient's symptoms of severe abdominal pain and vomiting large amounts of fresh blood are classic for a bleeding peptic ulcer. The presence of several laparotomy scars suggests a history of abdominal surgeries, which could be related to previous peptic ulcer disease or its complications.
- Other Likely diagnoses
- Gastroesophageal varices: Although the patient is well perfused and has a normal hemoglobin level, the history of vomiting large amounts of blood could still suggest bleeding from gastroesophageal varices, especially if the patient has a history of liver disease.
- Mallory-Weiss syndrome: This condition, characterized by tears in the mucous membrane of the lower end of the esophagus, could cause vomiting blood, especially if the patient has a history of intense or prolonged vomiting.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection or rupture: Although the patient's symptoms do not directly suggest this diagnosis, severe abdominal pain can be a presentation of aortic dissection or rupture, which would be catastrophic if missed.
- Mesenteric ischemia: This condition, which involves insufficient blood flow to the intestines, can cause severe abdominal pain and vomiting, and would require prompt diagnosis and treatment to prevent serious complications.
- Boerhaave's syndrome: This condition, characterized by a spontaneous rupture of the esophagus, can cause severe chest or abdominal pain and vomiting blood, and would require immediate surgical intervention.
- Rare diagnoses
- Dieulafoy's lesion: This rare condition, characterized by a small, bleeding ulcer in the stomach or intestine, could cause vomiting blood, but is less likely than other diagnoses.
- Hemobilia: This condition, characterized by bleeding into the biliary tree, could cause vomiting blood, but is relatively rare and would typically be associated with other symptoms such as jaundice.