A 74-year-old man presented to the emergency department due to an episode of bloody vomiting. The patient is known to have alcohol use disorder, he consumes 5 cans of beer daily. Temperature is 36.7 C (98 F), blood pressure is 90/60 mm Hg, the pulse is 120/min, and respirations are 23/min. On examination, the patient has yellowish skin and scleral discoloration. Abdominal examination shows an enlarged spleen. Upper gastrointestinal endoscopy shows bleeding in dilated tortuous veins found in the esophagus. This patient's presentation is due to shunting of blood through which of the following structures?

Question

Quizplus · Accepted Answer

Eductional Objective: Cirrhosis is the most common cause of portal hypertension, due to the increased resistance to blood flow through the hepatic sinusoids. This would build portosystemic shunts to overcome the increased blood pressure in the portal system. Dilatation of collateral veins responsible for the shunts is the cause of esophageal varices, caput medusa, and anorectal varices.

A 74-Year-Old Man Presented to the Emergency Department Due to an Episode