Medicine

A 45-year-old man is brought to the emergency department after vomiting up frank blood. This has never occurred before and he reports no prior symptoms of nausea, vomiting, or ASA/ NSAID use. His past health history is significant for chronic alcoholism.On physical examination, his blood pressure is 94/73 mm Hg, heart rate 110/min, and thereare signs of chronic liver disease. He is resuscitated with IV fluids (normal saline) and undergoes urgent endoscopy which reveals the findings shown in Figure below. Which of the following is the most likely diagnosis?