Question

A patient presents with sudden onset of hematemesis. He has been taking aspirin for his arthritis and drinks alcohol occasionally. He gives a history of occasional abdominal pain. On examination, there is no abdominal mass or tenderness. What is the likely diagnosis?

• A. Mallory-Weiss tear
• B. Esophagitis
• C. Peptic ulcer
• D. Esophageal varices

Answer 1

The Correct Option is C

The patient presents with sudden onset of hematemesis, which is vomiting blood. This is a serious symptom indicating a possible bleed in the upper gastrointestinal tract. Next, we analyze the contributing factors:

• Aspirin Use: The patient has been taking aspirin, a non-steroidal anti-inflammatory drug (NSAID), which is known to cause or exacerbate gastric mucosal damage leading to bleeding.
• Alcohol Consumption: Occasional alcohol intake can irritate the gastric lining and also contribute to mucosal damage.
• Abdominal Pain: The patient reports a history of occasional abdominal pain, which aligns with possible gastritis or peptic ulcer disease.

On examining the symptoms and contributing factors, we assess the options:

• Mallory-Weiss Tear: This involves tears at the gastroesophageal junction due to severe vomiting or retching; however, no repetitive vomiting history is noted.
• Esophagitis: Inflammation of the esophagus could cause such symptoms, but aspirin and alcohol are more directly linked to gastric rather than esophageal issues.
• Peptic Ulcer: Given the history of aspirin use, alcohol consumption, and abdominal pain, a peptic ulcer leading to upper gastrointestinal bleeding is highly plausible. NSAIDs like aspirin can directly cause ulceration.
• Esophageal Varices: Often related to liver disease and portal hypertension, with no signs or history indicative of such in this patient.

Based on the information, the most likely diagnosis is a Peptic Ulcer as it correlates with the patient's medication, lifestyle, and symptoms. The use of aspirin and episodic alcohol consumption are significant risk factors for developing gastric mucosal damage leading to a peptic ulcer.