A 44-year-old man comes to the emergency department because of three episodes of hematemesis and lightheadedness. He has no medical history of gastrointestinal bleeding, bleeding disorders, alcoholism, chronic liver disease, cardiovascular disease, or cancer and he does not take any medications.
On examination, his temperature is 98.6 °F, blood pressure is 113/66 mm Hg supine and 80/54 mm Hg standing, pulse rate is 103/min supine and 127/min standing, and respiration rate is 16/min. He has no jaundice, spider angiomata, or palmar erythema. The abdominal shows no tenderness, guarding, or rebound. FOBT is positive for blood in the stool.
Lab Results:
Hemoglobin 10.1 g/dL
Platelet count 210,000/µL
Prothrombin time 12 s
Alanine aminotransferase 30 U/L
Aspartate aminotransferase 26 U/L
Blood urea nitrogen 36 mg/dL
Creatinine 1 mg/dL
Which of the following is the most likely cause of this person's bleeding?
A. Peptic Ulcer Disease
B. Angiodysplasia
C. Portal Gastropathy
D. Erosive Gastritis
E. Esophageal Varices
Reference:
Kim JJ, Sheibani S, Park S, Buxbaum J, Laine L. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014 Feb;48(2):113-8. PMID: 23685847