A patient with a history of liver disease presents with sudden hematemesis after several days of illness and is unstable. Which diagnosis is most likely?

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Multiple Choice

A patient with a history of liver disease presents with sudden hematemesis after several days of illness and is unstable. Which diagnosis is most likely?

In liver disease, portal hypertension causes esophageal varices to form and many of these veins can rupture suddenly, leading to massive hematemesis and rapid hemodynamic instability. This makes an esophageal variceal bleed the most likely cause when a patient with known liver disease presents with a sudden, heavy amount of blood in vomiting and is unstable. Mallory-Weiss tears stem from forceful vomiting causing a mucosal tear at the gastroesophageal junction and are less specifically tied to cirrhosis, though they can bleed. Peptic ulcers and gastritis can cause bleeding, but without the clear link to portal hypertension, they’re less likely to explain this rapid, life-threatening presentation in someone with liver disease.

In liver disease, portal hypertension causes esophageal varices to form and many of these veins can rupture suddenly, leading to massive hematemesis and rapid hemodynamic instability. This makes an esophageal variceal bleed the most likely cause when a patient with known liver disease presents with a sudden, heavy amount of blood in vomiting and is unstable.

Mallory-Weiss tears stem from forceful vomiting causing a mucosal tear at the gastroesophageal junction and are less specifically tied to cirrhosis, though they can bleed. Peptic ulcers and gastritis can cause bleeding, but without the clear link to portal hypertension, they’re less likely to explain this rapid, life-threatening presentation in someone with liver disease.

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