40-year-old chronic alcoholic presents with distended abdomen, hematemesis and fresh blood in stool. On examination huge ascites and distended veins over abdominal wall are noted. Most likely cause of hematemesis is.
## **Core Concept**
The patient's presentation suggests liver cirrhosis with portal hypertension, characterized by ascites, abdominal wall varices, hematemesis, and fresh blood in stool. Portal hypertension leads to the formation of varices, which are prone to bleeding.
## **Why the Correct Answer is Right**
The correct answer, **C. Esophageal varices**, is the most likely cause of hematemesis in this context. In liver cirrhosis, portal hypertension causes blood to be shunted through collateral veins, leading to the formation of esophageal varices. These varices are highly susceptible to rupture, resulting in hematemesis. The presence of ascites and distended abdominal veins supports the diagnosis of portal hypertension.
## **Why Each Wrong Option is Incorrect**
* **Option A:** Gastric ulcer is less likely as the primary presentation would be epigastric pain and not necessarily associated with huge ascites and abdominal wall varices.
* **Option B:** Duodenal ulcer might present with hematemesis but is not directly related to the signs of portal hypertension like ascites and abdominal wall varices.
* **Option D:** Mallory-Weiss syndrome involves tears in the mucosa of the lower end of the esophagus and could cause hematemesis but is less directly linked to the chronic liver disease and portal hypertension signs presented.
## **Clinical Pearl / High-Yield Fact**
In patients with liver cirrhosis and portal hypertension, esophageal varices are a major cause of upper gastrointestinal bleeding. The presence of stigmata of chronic liver disease (e.g., ascites, jaundice) and signs of portal hypertension (e.g., abdominal wall varices) should prompt an early endoscopic evaluation for varices.
## **Correct Answer: C. Esophageal varices**