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

Step 1: Understanding the Question:
An 18-year-old has massive hematemesis, a two-week history of fever treated with drugs, and a moderately enlarged spleen. We need to pick the diagnosis that explains the bleeding.

Step 2: Key Formula or Approach:
Splenomegaly plus hematemesis in a young patient should raise suspicion of a portal hypertensive source of bleeding rather than a simple mucosal ulcer, so weigh each option against that pattern.

Step 3: Detailed Explanation:
An NSAID-induced duodenal ulcer does not explain the splenomegaly, and there is no history of NSAID use given in the vignette, so this option does not fit the whole picture.
Drug-induced gastritis also fails to explain the splenomegaly, and gastritis rarely causes hematemesis this massive on its own.
Portal hypertension is the underlying state that raises pressure in the portal venous system, but it is not itself the visible bleeding lesion, it is the mechanism behind one.
Esophageal varices are the dilated submucosal veins at the lower esophagus that form because of portal hypertension, and they are the actual site that ruptures and bleeds massively. Given the splenomegaly (from portal hypertension, here likely following the febrile illness) and the massive hematemesis, the direct diagnosis for the bleeding source is esophageal varices.

Step 4: Final Answer:
The diagnosis is esophageal varices, which are the ruptured vessels actually responsible for the massive hematemesis, with portal hypertension and splenomegaly as the setting behind them.