Differential Diagnosis for Vomiting with Flecks of Blood

• Single most likely diagnosis:

  • Mallory-Weiss syndrome: This condition is characterized by 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 blood may be vomited up, appearing as flecks in the vomit. The syndrome is often associated with intense or prolonged vomiting, retching, or coughing but can also be caused by anything that leads to a sudden increase in abdominal pressure, such as heavy lifting or severe straining during bowel movements.

• Other Likely diagnoses:

  • Gastroesophageal reflux disease (GERD): While GERD itself does not typically cause bleeding, severe cases can lead to esophagitis (inflammation of the esophagus), which might result in minor bleeding.
  • Peptic ulcer disease: Ulcers in the stomach or the first part of the small intestine (duodenum) can bleed, and if the bleeding is not severe, it might appear as flecks of blood in the vomit.
  • Esophagitis: Inflammation of the esophagus, which can be caused by infection, allergies, or certain medications, might lead to bleeding.

• Do Not Miss diagnoses:

  • Boerhaave's syndrome: A severe and life-threatening condition where there is a full-thickness tear through the esophageal wall, often requiring immediate surgical intervention. It's less common than Mallory-Weiss syndrome but critical not to miss due to its high mortality rate if not promptly treated.
  • Variceal bleeding: Enlarged veins in the esophagus (esophageal varices) or stomach (gastric varices), usually due to liver cirrhosis, can rupture and cause severe bleeding. While the bleeding is often more profound, in some cases, it might initially present with flecks of blood in the vomit.

• Rare diagnoses:

  • Dieulafoy's lesion: A rare cause of gastrointestinal bleeding, characterized by a small, usually solitary mucosal defect with an exposed, often large caliber, artery at its base. It can cause significant bleeding but is less common.
  • Hemobilia: Bleeding from the bile ducts into the gastrointestinal tract, which can be due to various causes including trauma, tumors, or vascular malformations. It's rare and might present with vomiting blood, among other symptoms.
  • Gastric cancer: Though rare as a cause for vomiting blood with flecks, advanced gastric cancer can erode into blood vessels, leading to bleeding. It's essential to consider in the differential diagnosis, especially in high-risk populations or those with unexplained weight loss, abdominal pain, or other systemic symptoms.