Differential Diagnosis for Spitting up Blood
- Single most likely diagnosis:
- Gastroesophageal reflux disease (GERD): This condition is characterized by the backflow of stomach acid into the esophagus, which can cause irritation and lead to bleeding. It's a common condition that can cause spitting up blood, especially in individuals with a history of GERD or those who experience frequent heartburn.
- Other Likely diagnoses:
- Peptic ulcer disease: Ulcers in the stomach or duodenum can bleed and cause hematemesis (spitting up blood). The risk factors for peptic ulcer disease include NSAID use, Helicobacter pylori infection, and a history of ulcers.
- Pneumonia or bronchitis: Infections in the lungs can cause coughing up blood (hemoptysis), which may be mistaken for spitting up blood. Pneumonia or bronchitis should be considered, especially in individuals with respiratory symptoms.
- Esophagitis: Inflammation of the esophagus can cause bleeding and spitting up blood. This can be due to various causes, including acid reflux, infections, or allergic reactions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Pulmonary embolism: Although less common, a pulmonary embolism can cause sudden onset of hemoptysis, which requires immediate medical attention.
- Esophageal cancer: Bleeding from esophageal cancer can present as spitting up blood. Although rare, it's essential to consider this diagnosis, especially in individuals with risk factors such as smoking or a family history of cancer.
- Aortic dissection or rupture: In rare cases, an aortic dissection or rupture can cause bleeding that may be coughed up or spat out. This is a medical emergency that requires prompt attention.
- Rare diagnoses:
- Dieulafoy's lesion: A rare condition characterized by a small, bleeding ulcer in the stomach or duodenum.
- Hemobilia: Bleeding from the bile ducts can cause hematemesis, although this is a rare condition.
- Arteriovenous malformation (AVM): A rare congenital condition that can cause bleeding in the lungs or gastrointestinal tract, leading to spitting up blood.