An young man is brought to casualty with history of hematemesis. There is mild splenomegaly on examination. Cause of bleeding is: March 2009

Ans. B: Oesophageal varices Physical findings in esophageal varices: Pallor may suggest active internal bleeding. Low blood pressure, increased pulse rate, and postural drop of blood pressure may suggest blood loss. Parotid enlargement may be related to alcohol abuse and/or malnutrition. A hyperdynamic circulation with flow murmur over the pericardium may be present. Jaundice may be present because of impairment of liver function. Telangiectasis of the skin, lips, and digits may be present. Gynecomastia in males results from failure of the liver to metabolize estrogen, resulting in a sex hormone imbalance. Fetor hepaticus occurs in poosystemic encephalopathy of any cause (e.g., cirrhosis). Palmar erythema and leuconychia may be present in patients with cirrhosis. Ascites, abdominal distention due to accumulation of fluid, may be present.. Distended abdominal wall veins may be present, with the direction of venous flow away from the umbilicus. Splenomegaly occurs in poal hypeension. Testicular atrophy is common in males with cirrhosis, paicularly those with alcoholic liver disease or hemachromatosis. Venous hums, continuous noises audible in patients with poal hypeension, may be present as a result of rapid turbulent flow in collateral veins. During the rectal examination,a black, soft, tarry stool on the gloved examining finger suggests upper GI bleeding.