A 70-year-old male with abdominal pain and vomiting dark material after a period of stress; which diagnosis is most likely?

• A. Abdominal aortic aneurysm caused by increased blood pressure.
• B. Gastric ulcer caused by stress.
• C. Ruptured esophageal varices caused by a bacterial infection.
• D. Cholecystitis caused by increased bile production.

Answer: (B)

Physiologic stress can cause mucosal injury in the stomach, leading to a stress-related gastric ulcer and upper GI bleeding. In a patient who has endured a period of stress and now has abdominal pain with vomiting of dark material, the dark emesis likely represents digested blood from a gastric ulcer bleed. This pattern fits a stress-related mucosal disease that erodes the gastric mucosa.

Abdominal aortic aneurysm would typically cause severe, possibly tearing back or abdominal pain with a pulsatile mass or signs of shock, not dark vomiting from GI bleeding. Esophageal variceal rupture is tied to portal hypertension from liver disease and usually presents with massive, abrupt hematemesis, not specifically linked to a recent stress event. Cholecystitis presents with RUQ pain, sometimes vomiting, but not dark, blood-tinged material from a GI bleed.