Differential Diagnosis for Vomiting Blood

Single Most Likely Diagnosis

• Peptic Ulcer Disease: This is the most common cause of vomiting blood (hematemesis), often due to gastric or duodenal ulcers. The justification for this being the single most likely diagnosis is based on its high prevalence and the common presentation of upper gastrointestinal bleeding.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): Although less common than peptic ulcers as a cause of hematemesis, severe GERD can lead to esophageal ulcers or erosions that bleed.
• 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, and the syndrome is often associated with intense or prolonged vomiting, retching, or coughing.
• Esophagitis: Inflammation of the esophagus, often due to acid reflux, can cause bleeding.

Do Not Miss Diagnoses

• Variceal Bleeding: Bleeding from esophageal varices is a life-threatening condition often associated with liver cirrhosis and portal hypertension. It requires immediate medical attention.
• Gastric Cancer: Although less common, gastric cancer can present with hematemesis. Given its severity and the importance of early diagnosis, it is crucial not to miss this condition.
• Aortic Enteric Fistula: A rare but potentially fatal condition where there is a fistula between the aorta and the gastrointestinal tract, leading to massive bleeding.

Rare Diagnoses

• Dieulafoy's Lesion: A rare cause of gastrointestinal bleeding characterized by a small mucosal defect with an exposed, often large, caliber artery at its base.
• Hemobilia: Bleeding into the biliary tree, which can lead to hematemesis if the blood enters the gastrointestinal tract.
• Angiodysplasia: Vascular malformations of the gastrointestinal tract that can cause bleeding, more commonly seen in the elderly.

Each of these diagnoses has a different level of urgency and requires a tailored approach to diagnosis and treatment. The key to managing a patient with hematemesis is to quickly identify the source of bleeding and assess the severity to guide appropriate intervention.