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Man Vomits Blood in ER After Switching Pain Meds - Can You Diagnose?


A 62-year-old man went to the emergency room complaining of epigastric pain. As a nurse took his vitals, he vomited blood.

Three months earlier, he had been at his primary care doctor complaining about knee pain. He was originally prescribed diclofenac. Diclofenac gave him terrible heartburn so the primary care doctor switched him to naproxen with codeine, which he had been taking regularly over the past week.

Is it a gastric ulcer, gastritis, a myocardial infarction, or esophagitis?

Check out our differential in VisualDx.

The correct diagnosis is...

About VisualDx

VisualDx is an award-winning diagnostic clinical decision support system that has become the standard electronic resource at more than half of U.S. medical schools and more than 1,500 hospitals and institutions nationwide.  VisualDx combines clinical search with the world's best medical image library, plus medical knowledge from experts to help with diagnosis, treatment, self-education, and patient communication. Expanding to provide diagnostic decision support across General Medicine, the new VisualDx brings increased speed and accuracy to the art of diagnosis. Learn more at