A patient with cirrhosis is at risk for esophageal variceal bleeding. Which finding would be most concerning?

• A. Epistaxis
• B. Melena
• C. Hematemesis
• D. Jaundice

Answer: (C)

In cirrhosis with portal hypertension, esophageal varices can rupture and cause upper GI bleeding. The finding that is most concerning is vomiting blood because it signals active, ongoing variceal hemorrhage and potential rapid blood loss. This situation is an emergency: it demands immediate airway protection if needed, rapid fluid resuscitation with IV access, blood crossmatch and transfusion as indicated, and prompt initiation of therapies to reduce bleeding (such as vasoactive meds) and definitive control with endoscopic variceal ligation, plus antibiotics to prevent infection in cirrhotic patients.

Epistaxis can occur but is not tied specifically to portal hypertension or variceal bleeding, so it’s less alarming in this context. Melena shows digested blood from an upper GI bleed, but it can reflect slower bleeding or a bleed that has already occurred; it doesn’t convey the same immediacy as active hematemesis. Jaundice signals chronic liver dysfunction rather than an acute bleed.