Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

Esophageal varices is good possibility to explain the bleeding, but this diagnosis won't really address the issue of his pain.

Varices result from venous portal hypertension, most often secondary to cirrhosis of the liver. although so called "cryptogenic" (hidden or undiagnosed) cirrhosis is a possibility it's is unlikely. 

• liver enzymes don't fit (can you tell from the chemistry panel which those would be?)
• again, the pain is not consistent

• Congenital abnormality such as an esophageal or gastric diverticulum or vascular malformation.
• Gastric or duodenal ulcer.
• Gastric carcinoma.
• Esophagitis
• Gastritis