Differential Diagnosis for Hemorrhagic Gastritis versus PUD
Single Most Likely Diagnosis
- Peptic Ulcer Disease (PUD): This is the most likely diagnosis due to the common presentation of hemorrhage in the stomach, which can be caused by ulcers in the gastric lining. PUD is a well-known cause of upper gastrointestinal bleeding.
Other Likely Diagnoses
- Hemorrhagic Gastritis: Inflammation of the stomach lining leading to bleeding, which could be caused by various factors including alcohol use, NSAIDs, or stress. This condition presents similarly to PUD and is a common cause of upper GI bleed.
- Gastric Erosions: Similar to PUD but typically more superficial and often related to stress or NSAID use. These can also cause significant bleeding.
- Mallory-Weiss Syndrome: Tears in the mucous membrane or lining of the lower end of the esophagus, where it connects to the stomach, often due to intense or prolonged vomiting, retching, or coughing. This can lead to bleeding.
Do Not Miss Diagnoses
- Variceal Bleeding: Although less common than PUD or hemorrhagic gastritis, variceal bleeding due to liver cirrhosis and portal hypertension can present with severe upper GI hemorrhage and has a high mortality rate if not promptly recognized and treated.
- Gastric Cancer: A less common cause of upper GI bleeding but critical to diagnose early due to its potential for severe outcomes. Bleeding can be the initial presentation of gastric cancer.
- Dieulafoy's Lesion: A rare but important cause of GI bleeding, characterized by a small, superficial ulceration with an exposed, often large, caliber artery at its base. It can cause severe, recurrent bleeding.
Rare Diagnoses
- Gastric Antral Vascular Ectasia (GAVE): Also known as watermelon stomach, this condition is characterized by vascular ectasias in the antrum of the stomach, leading to chronic blood loss and iron deficiency anemia.
- Angiodysplasia: Vascular malformations of the gut that can cause chronic or acute bleeding. They are more common in the elderly and can be challenging to diagnose.
- Infectious Gastritis: Certain infections (e.g., CMV, particularly in immunocompromised patients) can cause gastritis and bleeding, though this is less common than other causes listed here.