Vomiting of Blood (Hematemesis): Or something else? Differential Diagnosis

Blood, blood-forming organs-immune system (D50-D90).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Scurvy (vitamin C deficiency)

Cardiovascular system (I00-I99)

  • Aorto-intestinal fistula (AEF) – connection between the aorta and the gastrointestinal tract – rare but life-threatening complication in the spontaneous course of an aortic aneurysm (primary form) or else as a postoperative event after prosthetic replacement of the aorto-iliac vascular segment (secondary fistula).
  • Vascular lesions (vascular injuries), unspecified.
  • Osler-Weber-Rendu disease (synonyms: Osler disease; Osler syndrome; Osler-Weber-Rendu disease; Osler-Rendu-Weber disease; hereditary hemorrhagic telangiectasia, HHT) – autosomal-dominant inherited disorder in which telangiectasias (abnormal dilation of blood vessels) occur. These can occur anywhere, but are found especially in the nose (leading symptom: epistaxis (nosebleed)), mouth, face, and the mucous membranes of the gastrointestinal tract. Because the telangiectasias are very vulnerable, it is easy to tear and thus bleeding.

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Gallstone perforation (rupture of the external bile ducts as a result of a gallstone leading to wall damage, with or without passage of the same) of the duodenum (duodenum)
  • Hemobilia – bleeding within the bile ducts, mostly with leakage of blood from the papilla duodeni major (papilla Vateri).

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Acute gastritis (inflammation of the gastric mucosa).
  • Acute mesenteric ischemia (AMI) or mesenteric infarction – acute occlusion of the blood vessels supplying the intestine.
  • Boerhaave syndrome – spontaneous rupture of the esophagus (esophagus); usually after massive vomiting.
  • Dieulafoy lesion (synonym: exulceratio simplex) – rare form of bleeding ventriculi ulcer (gastric ulcer), which can occur in a congenital anomaly of blood vessels of the stomach wall.
  • Erosive duodenitis (duodenitis).
  • Erosive gastritis (gastritis).
  • Fundus varices – varicose veins in the upper part of the stomach.
  • Gastrointestinal bleeding (GIB) – bleeding from the digestive tract.
  • Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
  • Mallory-Weiss syndrome – clustered longitudinal (elongated) tears of the mucosa (mucous membrane) and submucosa (submucosal connective tissue) of the esophagus occurring in alcoholics, which may be associated with potentially life-threatening hemorrhage of the external esophagus and/or gastric inlet (gastrointestinal hemorrhage/GIB) as a complication
  • Esophageal varices – varicose veins in the esophagus, usually due to liver cirrhosis (irreversible damage to the liver leading to gradual connective tissue remodeling of the liver with impairment of liver function)
  • Peptic ulcer (ulcer in the gastrointestinal tract caused by hydrochloric acid):
    • Ulcus ventriculi (gastric ulcer).
    • Duodenal ulcer (duodenal ulcer)
    • Ulcus pepticum jejuni (jejunum (empty intestine; one of the three sections of the small intestine; connects to the duodenum (duodenum)).

Musculoskeletal system and connective tissue (M00-M99).

  • Periarteritis nodosa – necrotizing vasculitis (vascular inflammation), usually affecting medium-sized vessels.
  • Systemic lupus erythematosus (SLE) – systemic disease affecting the skin and connective tissue of the vessels, leading to vasculitides (vascular inflammation) of numerous organs, such as the heart, kidneys or brain

Neoplasms – tumor diseases (C00-D48).

  • Leukemia (blood cancer)
  • Gastric carcinoma (stomach cancer)
  • Mediastinal tumor (neoplasm originating from the mediastinal cavity) that perforates the esophagus or aorta (main artery)
  • Esophageal carcinoma (cancer of the esophagus).

Psyche – nervous system (F00-F99; G00-G99)

  • Munchausen syndrome with intentional swallowing and vomiting of blood.

Injuries, poisonings, and other sequelae of external causes (S00-T98).

  • Arsenic poisoning
  • Poisoning by acids, bases
  • Injuries of the esophagus (esophagus), unspecified.

Medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) result in a three- to fivefold increase in the risk of upper gastrointestinal tract complications (upper GI bleeding, perforation/breakthrough, ulcer/ulcer); complications are dose dependent
  • See also drug side effects, under:
    • “Bleeding due to medications”
    • “Platelet dysfunction due to drugs”

Environmental pollution – intoxications (poisoning).

  • Arsenic poisoning
  • Poisoning by acids, bases

Other causes

  • Foreign body
  • Swallowed blood – due to bleeding from nose or lungs