Differential Diagnosis for Upper GIT Bleeding

The patient presents with upper gastrointestinal (GIT) bleeding, and all investigations and coagulation tests are normal. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • B. Peptic ulcer: This is the most common cause of upper GIT bleeding in adults. Peptic ulcers can cause significant bleeding and are often associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The fact that all investigations and coagulation tests are normal does not rule out a peptic ulcer, as these tests do not directly diagnose ulcers.

• Other Likely Diagnoses

  • D. Mallory Weiss tear: This condition involves a tear in the mucous membrane or lining of the lower end of the esophagus, where it connects to the stomach. It is often associated with intense or prolonged vomiting, retching, or coughing but can also occur without these symptoms. It's a plausible cause of upper GIT bleeding, especially if the patient has a history of such activities.
  • A. Dieulafoy lesion: A rare but important cause of upper GIT bleeding, characterized by a small, superficial ulceration with an exposed, often large, caliber artery at its base. It can cause significant bleeding and is usually found in the stomach.

• Do Not Miss Diagnoses

  • E. Oesophageal varices: Although less common than peptic ulcers, esophageal varices are a critical diagnosis not to miss due to their high mortality rate if bleeding occurs. Varices are enlarged veins in the esophagus that can bleed easily due to increased pressure, often from liver cirrhosis. The fact that coagulation tests are normal does not rule out varices, as the primary issue is mechanical (enlarged veins) rather than a coagulopathy.
  • C. Angiodysplasia: These are vascular malformations of the gut and can cause bleeding. They are more common in the elderly and can be difficult to diagnose. Although less likely, missing this diagnosis could lead to recurrent bleeding episodes.

• Rare Diagnoses

  • Other rare causes of upper GIT bleeding might include gastric antral vascular ectasia (GAVE), hemobilia, or bleeding from a gastrointestinal tumor. However, these are less common and would be considered after ruling out the more likely causes listed above.

Each of these diagnoses has a different approach to management and treatment, emphasizing the importance of a thorough diagnostic workup to determine the underlying cause of the upper GIT bleeding.