A 51-year-old man has a sudden onset of massive emesis of bright red blood. On physical examination, his temperature is 36.9deg C, pulse is 103/min, respirations are 23/min, and blood pressure is 85/50 mm Hg. His spleen tip is palpable. Laboratory studies show a hematocrit of 21%. The serologic test result for HBsAg is positive. He has had no prior episodes of hematemesis. The hematemesis is most likely to be a consequence of which of the following?
Variceal bleeding is a common complication of hepatic cirrhosis, which can be an outcome of chronic hepatitis B infection. Portal hypertension leads to dilated submucosal esophageal veins that can erode and bleed profusely. Barrett esophagus is columnar metaplasia that results from gastroesophageal reflux disease (GERD). Bleeding is not a key feature of this disease. Esophageal candidiasis may be seen in immunocompromised patients, but it most often produces raised mucosal plaques and is rarely invasive. GERD may produce acute and chronic inflammation and, rarely, massive hemorrhage. Esophageal carcinomas may bleed, but not enough to cause massive hematemesis. A Zenker diverticulum is located in the upper esophagus and results from cricopharyngeal motor dysfunction; it presents a risk for aspiration, but not for hematemesis.
Barrett esophagus
Candida albicans infection
Esophageal varices
Reflux esophagitis
G.I.T.