Differential Diagnosis for Vomiting Blood
- Single most likely diagnosis
- Peptic ulcer disease: This is the most common cause of vomiting blood (hematemesis), often due to Helicobacter pylori infection or non-steroidal anti-inflammatory drug (NSAID) use, leading to gastric or duodenal ulcers.
- Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): Chronic reflux can lead to esophagitis and potentially cause bleeding.
- Gastritis: Inflammation of the stomach lining can cause bleeding, often due to alcohol use, NSAIDs, or stress.
- Esophageal varices: Enlarged veins in the esophagus, usually due to liver cirrhosis, can rupture and cause severe bleeding.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Boerhaave syndrome: A rare but life-threatening condition where the esophagus ruptures, often due to forceful vomiting.
- Aortic rupture or dissection: Although rare, this can cause vomiting blood if there is an aortoesophageal fistula.
- Mallory-Weiss syndrome: Tears in the mucous membrane or lining of the lower end of the esophagus, often due to intense or prolonged vomiting.
- Rare diagnoses
- Hemobilia: Bleeding from the bile ducts into the gastrointestinal tract, often due to liver or biliary tract disease.
- Dieulafoy's lesion: A rare cause of gastrointestinal bleeding due to a small, superficial ulceration with an exposed, often large, artery.
- Gastric cancer: Although less common, gastric cancer can cause vomiting blood, especially in older adults or those with a family history.