Differential Diagnosis for Vomiting of Blood after Physical Assault
Single Most Likely Diagnosis
- Mallory-Weiss Tear: This is a common cause of vomiting blood (hematemesis) after physical assault, especially if the assault involved blunt trauma to the abdomen or chest, leading to forceful vomiting or retching, which can cause a tear in the mucous membrane or submucosa of the lower end of the esophagus.
Other Likely Diagnoses
- Gastritis: Physical assault can lead to stress, which may exacerbate or trigger gastritis, an inflammation of the stomach lining, potentially causing bleeding.
- Peptic Ulcer Disease: Stress from physical assault can also exacerbate peptic ulcers, leading to bleeding.
- Esophageal Tear (not limited to Mallory-Weiss): Besides Mallory-Weiss tears, other types of esophageal injuries from trauma can cause hematemesis.
Do Not Miss Diagnoses
- Boerhaave's Syndrome: A severe and life-threatening condition where there is a full-thickness tear of the esophagus, often associated with forceful vomiting. It requires immediate medical attention.
- Aortic Injury: Although rare, severe physical assault can lead to aortic injuries, which might present with hematemesis among other symptoms due to the proximity of the aorta to the esophagus and stomach.
- Splenic Injury: Bleeding from a splenic injury can occasionally present with hematemesis if there is a connection between the spleen and the stomach (e.g., through a fistula), though this is rare.
Rare Diagnoses
- Dieulafoy's Lesion: A rare cause of gastrointestinal bleeding, characterized by a small mucosal defect with an exposed, usually large, caliber artery at its base.
- Hemobilia: Bleeding into the biliary tree, which can be a result of trauma and might present with hematemesis among other symptoms like melena (black, tarry stools) and jaundice.
- Traumatic Pseudoaneurysm of the Gastroduodenal Artery: A rare complication of abdominal trauma, which can cause gastrointestinal bleeding.