Esophageal variceal bleeding typically presents as what in a patient with chronic liver disease?

• A. Life-threatening upper GI bleed: hematemesis, melena, hematochezia
• B. Chronic diarrhea
• C. Painless jaundice
• D. Lower abdominal pain

Answer: (A)

Esophageal variceal bleeding in chronic liver disease arises from portal hypertension causing fragile dilated veins in the distal esophagus to rupture. When this happens, it creates a brisk, life-threatening upper gastrointestinal hemorrhage. The hallmark presentation is vomiting blood (hematemesis) and black, tarry stools (melena) from digested blood; if the bleed is very rapid, you may also see fresh blood in the stool (hematochezia). This scenario fits the acute, upper GI nature of variceal hemorrhage, unlike symptoms such as chronic diarrhea, painless jaundice, or lower abdominal pain, which reflect other aspects of liver disease or different problems altogether.