A 50 yr old male presented with history of hematemesis - 500 ml of blood and on examination shows BP - 90/60, PR -110/min and splenomegaly 5 cm below lower costal margin. Most probable diagnosis is

Ans. is 'd' i.e. Portal hypertension Causes of Hematemesis (in decreasing order)Peptic ulcerDuodenal ulcer (Most common cause)Gastric ulcerEsophageal varices (portal hypertension)Mallory Weiss tearGastroduodenal erosionsErosive esophagitisNeoplasm of esophagus, stomach & duodenum.Vascular ectasias Here in this patient, splenomegaly is suggestive of portal hypertension.Mallory-Weiss tear is suggested if the patient presents in the classic pattern - initially vomiting is without blood, after retching and vomiting with epigastric pain, hematemesis occurs.Gastritis is usually associated with history of intake of NSAIDS, alcohol, corticosteroids and oral potassium supplements.