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?

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