Differential Diagnosis for Hematemesis in a 6-Month-Old with Multiple Episodes of Vomiting
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is common in infants and can cause vomiting, which may lead to hematemesis due to esophageal irritation or mucosal tears. The recurrent vomiting in this patient makes GERD a plausible explanation.
Other Likely Diagnoses
- Pyloric Stenosis: Although typically presenting with projectile vomiting, pyloric stenosis can occasionally lead to hematemesis, especially if there's significant force involved in vomiting, causing gastric mucosal tears.
- Gastroenteritis: Infections can cause inflammation of the stomach and intestines, leading to vomiting and potentially hematemesis, especially if the infection is severe or if there are complications like ulcers.
- Mallory-Weiss Tear: 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, causing hematemesis, and are often associated with intense or prolonged vomiting.
Do Not Miss Diagnoses
- Intussusception: Although more commonly associated with intestinal obstruction and bloody stools, intussusception can occasionally present with vomiting and, in rare cases, hematemesis, especially if there's significant bowel ischemia.
- Volvolus or Midgut Volvulus: These conditions involve twisting of the intestines, which can cut off blood flow and lead to ischemia, potentially causing vomiting and, in severe cases, hematemesis.
- Ingested Foreign Body: If the infant has ingested a sharp object, it could cause internal injury leading to bleeding. This is less common but critical to identify due to the potential for severe complications.
Rare Diagnoses
- Hemangioma or Other Vascular Anomalies: Rare vascular malformations in the gastrointestinal tract could potentially bleed, leading to hematemesis.
- Congenital or Acquired Coagulopathy: Bleeding disorders, either inherited or acquired, could predispose the infant to bleeding from minor gastrointestinal irritations or injuries.
- Gastric or Duodenal Ulcer: Although rare in infants, ulcers can cause significant bleeding. The use of certain medications or underlying conditions like Helicobacter pylori infection could contribute to their development.