Year 4common
A 52-year-old man presents to the emergency department with sudden onset of vomiting blood and lightheadedness. He reports passing black stools over the past few days.
He drinks approximately 80 units of alcohol per week and has been feeling increasingly tired and bloated over the last few months.
On examination, he is hypotensive (BP 88/60 mmHg) and tachycardic. He has mild scleral icterus, palmar erythema, and shifting dullness on abdominal percussion. Rectal exam confirms melaena. Initial resuscitation is started.
What is the most likely cause of this presentation?