Differential Diagnosis for Hematemesis

The differential diagnosis for hematemesis, which is the vomiting of blood, can be organized into several categories based on the likelihood and potential impact of missing a diagnosis.

• Single Most Likely Diagnosis

  • Peptic ulcer disease: This is the most common cause of hematemesis, resulting from ulcers in the stomach or duodenum. The justification for this being the single most likely diagnosis is its high prevalence and the common presentation of upper gastrointestinal bleeding.

• Other Likely Diagnoses

  • Gastroesophageal reflux disease (GERD) with esophagitis: Chronic reflux can lead to esophageal inflammation and potentially bleeding.
  • Gastritis: Inflammation of the stomach lining can cause bleeding, often due to alcohol, NSAIDs, or stress.
  • Esophageal varices: Enlarged veins in the esophagus, typically due to liver cirrhosis, can rupture and bleed.
  • Mallory-Weiss syndrome: Tears in the mucous membrane or lining of the lower end of the esophagus, often due to intense or prolonged vomiting.

• Do Not Miss Diagnoses

  • Aortic enteric fistula: A rare but potentially fatal condition where there's a connection between the aorta and the intestine, leading to massive bleeding.
  • Cancer (gastric or esophageal): Although less common, malignancies can cause hematemesis and have significant implications for treatment and prognosis.
  • Dieulafoy's lesion: A rare cause of gastrointestinal bleeding, characterized by a small, superficial ulceration with a large, exposed artery at its base.
  • Hemobilia: Bleeding into the biliary tree, which can be due to trauma, tumors, or vascular malformations.

• Rare Diagnoses

  • Angiodysplasia: Vascular malformations of the gastrointestinal tract that can cause bleeding.
  • Blue rubber bleb nevus syndrome: A rare condition characterized by vascular malformations that can lead to gastrointestinal bleeding.
  • Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): A genetic disorder leading to the formation of abnormal blood vessels, which can cause bleeding.
  • Gastric antral vascular ectasia (GAVE): Also known as watermelon stomach, characterized by vascular ectasias in the stomach, leading to chronic bleeding.