A 55-year-old man who has alcoholic cirrhosis is brought to the emergency department because he has been vomiting blood for 2 hours. He has a 2-month history of abdominal distention, dilated veins over the anterior abdominal wall, and internal hemorrhoids. Which of the following veins is the most likely origin of the hematemesis?
(A) Inferior mesenteric veins
(B) Left gastric vein
(C) Periumbilical veins
(D) Superior rectal vein
(E) Superior vena cava

Correct answer : (B) Left gastric vein

  • This is a case of bleed from esophageal varices due to portal hypertension
  • Venous drainage from the esophagus occurs via 2 routes
    • Major portion of the blood is drained via esophageal veins which drain into the azygos vein which in turn drains into the superior vena cava.
      • These vessels have no role in development of varices
    • The remaining blood drains via the superficial veins in the esophageal mucosa into the left gastric vein which in turn drains into the portal vein
      • These vessels become dilated and form varices in portal hypertension

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