In a patient with a history of alcoholism who is vomiting large amounts of bright red blood and shows signs of hypovolemic shock, what is the most likely diagnosis?

• A. Ulcers
• B. Esophageal varices
• C. Gastric cancer
• D. Gastroenteritis

Answer: (B)

Massive upper GI bleeding in someone with chronic alcoholism points to esophageal varices caused by portal hypertension from cirrhosis. Long-term alcohol use damages the liver, leading to scarring (cirrhosis) and increased pressure in the portal venous system. The veins in the lower esophagus become enlarged, and when one ruptures, it delivers a rapid, large amount of bright red blood, causing hypovolemic shock from the blood loss. This pattern fits best with the history and presentation.

Ulcers can bleed, but the strong link here is alcohol-related cirrhosis and portal hypertension. Gastric cancer tends to present with more gradual symptoms like weight loss and anemia rather than an abrupt, massive bleed. Gastroenteritis usually causes vomiting and diarrhea without catastrophic hematemesis.