In a patient with cirrhosis presenting with massive hematemesis, the most likely source is which condition?

• A. Peptic ulcer disease
• B. Esophageal varices
• C. Mallory-Weiss tear
• D. Gastric carcinoma

Answer: (B)

Portal hypertension from cirrhosis causes esophageal varices to form and easily rupture, making them the most common source of a massive upper GI bleed in this setting. The increased pressure in the portal system dilates veins at the gastroesophageal junction; these varices have thin walls and limited support, so they can bleed profusely, presenting as massive hematemesis. Other sources like peptic ulcers can bleed, but they aren’t specifically tied to cirrhosis, Mallory-Weiss tears usually follow forceful vomiting and aren’t as typically catastrophic in this context, and gastric cancer bleeding is less likely to present as an abrupt, massive bleed in a cirrhotic patient.