Differential Diagnosis for Bleeding PV Provisional Diagnosis

Single Most Likely Diagnosis

• Peptic Ulcer Disease: This is the most common cause of upper gastrointestinal bleeding, and the presentation of bleeding per rectum (PV) could be due to a massive upper GI bleed.

Other Likely Diagnoses

• Diverticulosis: This condition is common in older adults and can cause significant lower GI bleeding, presenting as PV bleeding.
• Colonic Polyps or Cancer: These can cause bleeding due to ulceration or tumor erosion, leading to PV bleeding.
• Angiodysplasia: This is a vascular malformation that can cause GI bleeding, often presenting as PV bleeding in older adults.
• Hemorrhoids: Although typically causing minor bleeding, severe hemorrhoidal disease can lead to significant PV bleeding.

Do Not Miss Diagnoses

• Mesenteric Ischemia: This is a life-threatening condition that can cause abdominal pain and GI bleeding. Although less common, missing this diagnosis can be fatal.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause significant GI bleeding and require prompt treatment to avoid complications.
• Arteriovenous Malformation (AVM): AVMs can cause significant, potentially life-threatening bleeding and require early diagnosis and treatment.

Rare Diagnoses

• Dieulafoy's Lesion: A rare cause of GI bleeding due to a mucosal defect overlying a persistent arteriole, which can cause massive bleeding.
• Intussusception: Although more common in children, intussusception can occur in adults and cause bowel obstruction and bleeding.
• Gastrointestinal Lymphoma: A rare malignancy that can cause GI bleeding among other symptoms.
• Vascular Disorders (e.g., Osler-Weber-Rendu Syndrome): Rare conditions that can lead to GI bleeding due to vascular abnormalities.