Which condition is most closely associated with painless hematemesis in a patient with cirrhosis?

• A. Peptic ulcer
• B. Esophageal tear
• C. Esophageal varices
• D. Hernia

Answer: (C)

Portal hypertension from cirrhosis causes dilation of veins in the esophagus, creating esophageal varices. When these fragile varices rupture, the bleed tends to be brisk and is often painless, producing hematemesis without accompanying abdominal pain. This painless presentation is a hallmark of variceal bleeding, setting it apart from other causes like peptic ulcers (which usually cause epigastric pain), Mallory-Weiss tears (typically painful after forceful vomiting), or hernias (which don’t typically cause sudden large-volume upper GI bleeding in a cirrhotic patient). So, the condition most closely linked to painless hematemesis in cirrhosis is esophageal varices.