A 29-year-old pregnant patient with severe vomiting and hematemesis; which diagnosis is most consistent?

• A. Esophagitis
• B. Acute pancreatitis
• C. Mallory-Weiss tear
• D. Esophageal varices

Answer: (C)

When severe vomiting leads to hematemesis, a tear at the junction where the esophagus meets the stomach is a classic pattern. This mucosal tear, produced by the force of retching, bleeds, and is especially likely in pregnancy when hyperemesis gravidarum causes repeated vomiting. That link between forceful vomiting and brisk bleeding after an episode points to Mallory-Weiss tear as the best fit.

Esophagitis usually presents with pain on swallowing and chest discomfort rather than a brisk bleed right after vomiting. Acute pancreatitis causes abdominal pain and elevated pancreatic enzymes rather than primary hematemesis tied to retching. Esophageal varices bleed due to portal hypertension and are typically related to underlying liver disease, which isn’t suggested here.