Differential Diagnosis for Hematemesis

The patient presents with an episode of hematemesis, mild anemia, and an elevated urea blood level, with no significant past medical history. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • C. Peptic Ulcer Disease: This is the most likely diagnosis given the presentation of hematemesis and the finding of mild anemia. Peptic ulcer disease can cause upper gastrointestinal bleeding, leading to hematemesis. The elevated urea level could be indicative of dehydration or a stress response, which can occur in the setting of significant blood loss.

• Other Likely Diagnoses

  • A. 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. These tears can bleed, leading to hematemesis. It's often associated with intense or prolonged vomiting, retching, or coughing but can also occur without these symptoms.
  • B. Erosive gastritis: This condition involves inflammation of the stomach lining, leading to erosions that can bleed. It can be caused by various factors, including non-steroidal anti-inflammatory drugs (NSAIDs), alcohol, stress, and infections. The presentation with hematemesis and mild anemia fits, although the absence of other symptoms like abdominal pain might make it slightly less likely than peptic ulcer disease.

• Do Not Miss Diagnoses

  • Although less common, variceal bleeding should be considered, especially if there's any suspicion of liver disease or portal hypertension. The elevated urea could be a non-specific finding, but significant upper GI bleed from varices can lead to hypovolemic shock and renal impairment, further elevating urea levels.
  • Gastrointestinal malignancy is another critical diagnosis not to miss, although it's less likely in a patient with no past medical history of significance. However, it can present with upper GI bleeding, and the mild anemia could be a sign of chronic blood loss.

• 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. It can cause significant bleeding and is usually found in the stomach.
  • Vascular malformations or angiodysplasia: These are rare conditions that can cause GI bleeding. They might be considered if other more common causes are ruled out, especially in the context of recurrent bleeding without a clear source.

Each of these diagnoses should be considered in the context of the patient's full clinical picture, including any additional symptoms, physical examination findings, and the results of further diagnostic testing such as endoscopy.