Differential Diagnosis for Nausea, Vomiting, and Coffee Ground Vomit
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD) with Esophagitis: The presence of coffee ground vomit suggests upper gastrointestinal bleeding, which can be caused by esophagitis due to chronic acid reflux in GERD. This condition is common and can lead to the symptoms described.
Other Likely Diagnoses
- Peptic Ulcer Disease: Both gastric and duodenal ulcers can cause upper GI bleeding, leading to coffee ground vomit. The nausea and vomiting can be associated with the pain and bleeding from the ulcers.
- Gastritis: Inflammation of the stomach lining can cause nausea, vomiting, and upper GI bleeding, especially if caused by NSAIDs, alcohol, or stress.
- Food Poisoning or Gastroenteritis: While more commonly associated with diarrhea, certain types of food poisoning or viral gastroenteritis can cause significant vomiting, including coffee ground vomit if there's associated bleeding.
Do Not Miss Diagnoses
- Mallory-Weiss Tear: A tear in the mucous membrane or lining of the lower end of the esophagus, where it connects to the stomach, can cause bleeding and coffee ground vomit. This condition is often associated with intense or prolonged vomiting, retching, or coughing.
- Boerhaave's Syndrome: A rupture of the esophagus, which is a medical emergency. It can present with severe chest pain, vomiting, and potentially coffee ground vomit if there's bleeding.
- Upper GI Cancer: Although less common, cancers of the stomach or esophagus can cause chronic bleeding, leading to coffee ground vomit, along with weight loss, difficulty swallowing, and abdominal pain.
Rare Diagnoses
- Dieulafoy's Lesion: A rare cause of upper GI bleeding characterized by a small mucosal defect with an exposed, often large, caliber artery at its base. It can present with sudden, severe bleeding and coffee ground vomit.
- Hemobilia: Bleeding into the biliary tree can cause vomiting of blood or coffee ground material, though this is exceedingly rare and usually associated with other symptoms like jaundice or abdominal pain.
- Portal Hypertension: In cases of liver cirrhosis or other causes of portal hypertension, bleeding from esophageal varices can lead to hematemesis (vomiting blood), which may appear as coffee ground vomit.