Differential Diagnosis for 28 y/o Patient with Vomiting Blood and Fatigue
Single most likely diagnosis
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of vomiting blood triggered by hot sauce or spicy food, along with fatigue, could be indicative of GERD. The consumption of spicy or acidic foods can exacerbate GERD symptoms, leading to esophageal irritation and potentially causing bleeding.
Other Likely diagnoses
- Peptic Ulcer Disease: This condition could also explain the patient's symptoms, as peptic ulcers can bleed, especially when irritated by spicy foods. The fatigue could be related to chronic blood loss.
- Gastritis: Similar to GERD and peptic ulcer disease, gastritis (inflammation of the stomach lining) could be irritated by spicy foods, leading to bleeding and fatigue due to blood loss.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Esophageal Varices: Although less common in a 28-year-old without a known history of liver disease, esophageal varices are a potentially life-threatening condition that could cause vomiting blood. The absence of other typical symptoms (e.g., liver disease signs) does not rule out this diagnosis entirely.
- Mallory-Weiss Syndrome: This condition involves 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 syndrome is often associated with intense or prolonged vomiting, retching, or anything that leads to a sudden increase in abdominal pressure, such as heavy lifting or straining with bowel movements.
Rare diagnoses
- Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid secretion, leading to severe peptic ulcer disease. While it's less likely, the symptoms of vomiting blood after consuming spicy foods could be considered, especially if other common causes are ruled out.
- 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. It could potentially cause the patient's symptoms but is less common and would be considered after ruling out more likely causes.