Differential Diagnosis for Vomiting Blood and Green Bile in Pregnancy
Single Most Likely Diagnosis
- Hyperemesis Gravidarum: This condition is characterized by severe nausea and vomiting during pregnancy, which can lead to dehydration and electrolyte imbalances. In severe cases, it can cause vomiting of blood (hematemesis) due to a Mallory-Weiss tear or green bile, indicating an obstruction or severe gastrointestinal irritation.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Pregnancy can exacerbate GERD symptoms due to increased intra-abdominal pressure and relaxation of the lower esophageal sphincter, leading to heartburn and potentially vomiting blood or bile.
- Peptic Ulcer Disease: The stress of pregnancy, along with potential increases in gastric acid production, can lead to the formation of peptic ulcers, which can cause vomiting of blood.
- Pregnancy-Induced Hypertension: Although less directly related to vomiting blood and bile, severe hypertension can lead to complications that might indirectly cause such symptoms, including HELLP syndrome, which affects liver function and could potentially lead to vomiting.
Do Not Miss Diagnoses
- Ectopic Pregnancy with Rupture: Although the primary symptom is usually abdominal pain, a ruptured ectopic pregnancy can lead to severe internal bleeding, which might be accompanied by vomiting, including blood or bile, due to the body's response to shock and stress.
- Placental Abruption: This condition involves the placenta separating from the uterus, which can cause severe abdominal pain, vaginal bleeding, and potentially vomiting due to pain and stress. It's less directly linked to vomiting blood and bile but is critical to diagnose due to its severe implications for both mother and fetus.
- Preeclampsia with Liver Involvement (HELLP Syndrome): This condition can lead to liver dysfunction and potentially cause nausea, vomiting, and abdominal pain. While less commonly associated directly with vomiting blood and bile, it's a critical diagnosis not to miss due to its severity.
Rare Diagnoses
- Acute Pancreatitis: Although rare in pregnancy, acute pancreatitis can cause severe abdominal pain, nausea, vomiting, and potentially vomiting of blood or bile if there's an associated ulcer or severe gastrointestinal irritation.
- Intestinal Obstruction: This is a rare condition in pregnancy but can cause severe vomiting, including bile, due to the obstruction of the intestines. It's less likely to cause hematemesis directly but could lead to it through complications like bowel ischemia.