Question

An 18-year-old presents with massive hematemesis and a history of fever for the past 14 days that was treated with drugs. A moderately enlarged spleen is present. What is the diagnosis?

• A. NSAID-induced duodenal ulcer
• B. Drug-induced gastritis
• C. Esophageal varices
• D. Portal hypertension

Hint:

Splenomegaly plus massive hematemesis in a young patient points to bleeding esophageal varices, the visible lesion, not just the underlying portal hypertension.

Answer 1

The Correct Option is C

This vignette gives an 18-year-old with a two-week fever treated with drugs, a moderately enlarged spleen, and massive hematemesis. The question is asking which option is the actual diagnosis behind the bleeding.

1. NSAID-induced duodenal ulcer: There is no mention of NSAID use, and this would not explain the splenomegaly, so it is unlikely.
2. Drug-induced gastritis: This also does not explain an enlarged spleen, and gastritis rarely produces bleeding this massive by itself.
3. Esophageal varices: The combination of splenomegaly and massive hematemesis in a young patient is the classic picture of bleeding from esophageal varices, dilated veins at the lower end of the esophagus that form when pressure rises in the portal venous system and rupture to cause dramatic blood loss.
4. Portal hypertension: This is the raised pressure state that causes the varices and the splenomegaly, but it is the mechanism, not the bleeding lesion itself.

Since the question is asking for the diagnosis that accounts for the bleeding, the answer is the visible lesion, esophageal varices, rather than the underlying mechanism of portal hypertension.

Let's summarize:

• Splenomegaly with massive hematemesis in a young patient points to a portal hypertensive source of bleeding.
• Esophageal varices are the actual ruptured vessels causing the bleed; portal hypertension is the state that produces them.

So the correct answer is esophageal varices.