A 63-year-old male with a history of alcoholism is vomiting bright red blood; which condition is suspected?

• A. peptic ulcer
• B. stomach cancer
• C. esophageal tear
• D. ruptured esophageal varices

Answer: (D)

Brisk hematemesis in a patient with a long history of alcoholism points to bleeding esophageal varices from portal hypertension due to cirrhosis. Alcohol-related liver disease raises pressure in the portal venous system, causing veins at the gastroesophageal junction to dilate. When one of these varices ruptures, blood can gush into the esophagus and stomach, producing bright red vomitus because the bleed is rapid and arterial-like in nature. This scenario fits best with variceal rupture.

While peptic ulcers can bleed, they’re less specifically tied to alcoholism, and stomach cancer usually presents with more chronic symptoms and gradual blood loss rather than a sudden, massive bleed. A Mallory-Weiss tear could cause hematemesis after forceful vomiting, but it’s typically linked to a recent retching episode and associated pain.