Coffee Ground Vomitus in a Patient with Alcohol Use Disorder and Known Gastritis

Case at a Glance

A 43-year-old male with a history of heavy alcohol use and gastritis presents with dark-colored vomitus resembling coffee grounds following a recent drinking binge, raising concern for upper gastrointestinal bleeding.

Patient's Story

The patient is a 43-year-old Caucasian male weighing 200 pounds with a significant history of heavy alcohol consumption. He presented with concerns about dark-colored vomit that occurred after a week-long drinking binge. He had been attempting to reduce his alcohol intake gradually over the past 2 days to avoid withdrawal symptoms. The vomiting episode occurred 1-2 hours after consuming a flavored alcoholic beverage. He reported a bloated sensation in his upper abdomen but denied any abdominal pain. The patient has a previous diagnosis of gastritis related to his alcohol use patterns.

Initial Assessment

Current medications include Bupropion 200mg, Propranolol 60mg, Atorvastatin 20mg, and Sertraline 50mg. Recent laboratory work from 2 weeks prior showed slightly elevated liver enzymes and vitamin D deficiency, but was otherwise unremarkable. A cardiac evaluation with echocardiogram performed months earlier was normal. The patient was scheduled for gastroenterology consultation the following day.

The Diagnostic Journey

The clinical presentation of dark vomitus following alcohol binge drinking in a patient with known gastritis raised immediate concern for upper gastrointestinal bleeding. The coffee ground appearance of the vomitus suggested the presence of partially digested blood, indicating a potential bleeding source in the upper GI tract. Given the patient's history of heavy alcohol use and gastritis, differential diagnoses included gastric mucosal irritation, peptic ulcer disease, esophageal varices, or Mallory-Weiss tear.

Final Diagnosis

Coffee ground vomitus secondary to upper gastrointestinal bleeding, likely related to alcohol-induced gastric mucosal injury in the setting of chronic gastritis and recent binge drinking.

Treatment Plan

Urgent gastroenterology evaluation was arranged for endoscopic assessment. The patient was advised to cease alcohol consumption immediately and monitor for signs of continued bleeding such as melena, hematemesis, or hemodynamic instability. Supportive care with proton pump inhibitors was likely indicated pending endoscopic findings.

Outcome and Follow-up

The patient was scheduled for gastroenterology consultation with likely upper endoscopy to identify and potentially treat the bleeding source. Alcohol cessation counseling and support services were recommended, along with close monitoring of liver function and nutritional status. Follow-up care would depend on endoscopic findings and the patient's commitment to alcohol reduction.