Differential Diagnosis for a 40-year-old Female with Hematemesis

Single Most Likely Diagnosis

• Peptic Ulcer Disease: This is the most common cause of upper gastrointestinal bleeding, which presents as hematemesis (vomiting blood). The patient's symptoms of repeated episodes of blood vomiting over 3 days align with a possible peptic ulcer that is bleeding.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD) with Esophagitis: Chronic GERD can lead to esophagitis, which may cause bleeding, especially if there are erosions or ulcers in the esophagus.
• 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 condition is often associated with intense or prolonged vomiting, retching, or coughing.
• Hemorrhagic Gastritis: Inflammation of the stomach lining can lead to bleeding, and this could be due to various causes including alcohol use, medications like NSAIDs, or stress.

Do Not Miss Diagnoses

• Esophageal Varices: These are enlarged veins in the esophagus that can bleed easily due to increased pressure, often from liver cirrhosis. Although less common than peptic ulcers, variceal bleeding can be life-threatening and requires immediate intervention.
• Aortic Enteric Fistula: A rare but potentially fatal condition where there's a connection between the aorta and the intestine, leading to massive gastrointestinal bleeding. This would be more likely in someone with a history of aortic surgery or disease.
• Cancer of the Stomach or Esophagus: Although less common, cancers in these areas can cause bleeding. Early diagnosis is crucial for treatment and survival.

Rare Diagnoses

• Dieulafoy's Lesion: A rare cause of gastrointestinal bleeding characterized by a small mucosal defect with an exposed, usually large, caliber artery at its base.
• Vascular Malformations or Angiodysplasia: Abnormal blood vessels in the gastrointestinal tract that can cause bleeding. These are more common in the elderly but can occur at any age.
• Ingested Foreign Body: Sharp objects can cause bleeding if they puncture the esophagus or stomach lining. This is less likely in an adult without a history of such ingestion but should be considered, especially if the onset of symptoms is sudden.

Each of these diagnoses should be considered based on the patient's full clinical presentation, including history, physical examination, and diagnostic tests such as endoscopy, which is crucial for directly visualizing the source of bleeding in the upper gastrointestinal tract.