An 18 year old male patient with history of fever for 2 weeks managed with OTC pills presents to the emergency depament with massive hemetemesis. Moderate splenomagaly is noted on clinical examination. What is most likely condition?

Correct Answer: Esophageal varices
Description: Hemorrhagic and erosive gastropathy (drug induced gastritis) do not cause major bleeding as in this case. So option drug induced gastritis is ruled out. Up to 10% of patients with NSAID-induced mucosal disease can present with a complication (bleeding, perforation, and obstruction) without antecedent symptoms. NSAID induced dudenal ulcer is more common in elderly population which rules out it as the diagnosis in this patient. Mallory-Weiss Tear generally follows Vomiting, retching, or vigorous coughing. So above all the most likey diagnosis in this young man is Esophageal varices. Ref: Harrison's Internal Medicine, 18th Edition, Pages 320-323, 2436-2437, 2441-2445
Category: Medicine
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