<prompt> A 40-year old male presents with history of vomiting of blood 2 hours ago. The volume of vomitus was estimated to be 500 ml. His BP was 9058 mm Hg and pulse was 110min. On abdominal examination, the spleen was palpable 5 cm below the costal margin. The most likely cause of the bleeding is:Portal hypertensionGastric ulcerDuodenal ulcerDrug-induced mucosal erosion  <response>: Ans. a. Portal hypertension Ref: Sabiston 19e p1164Splenomegaly and massive bleeding leading to hypotension and tachycardia in the patient are in favor of portal hypertension.Common Causes of Upper Gastrointestinal HemorrhageNon-variceal Bleeding80QPortal Hypertensive Bleeding20QPeptic ulcer disease MCQ30-50QGastroesophageal varicesQ90QMallory-Weiss tears15-20Hypertensive portal gastropathy5Gastritis or duodenitis10-15Isolated gastric varicesRareEsophagitis5-10 Arteriovenous malformations5 Tumors2 Other5 Portal HypertensionDefinition: Portal pressure 10 mm HgQMC cause of portal hypertension in United States: CirrhosisQ.Consequence of both increased portal vascular resistance and increased portal flowQ.Portal hypertension results in splenomegaly with enlarged, tortuous, and even aneurysmal splenic vessels.Splenomegaly frequently is associated with hypersplenism, causing leukopenia, thrombocytopenia, and anemia.Cruveilhier-Baumgarten murmurQ: Audible venous hum in caput medusaHyperdynamic portal venous circulation seems to be related to the severity of the liver failureQ.Upper G.I. bleeding is caused by the portal hypertension in about 90 of instances.Most bleeding episodes occur during the first 1 to 2 years after identification of varicesQ.Colour Doppler is the investigation of choice for evaluation of PHT.About one third of deaths in patients with known esophageal varices are due to upper GI bleedQA larger proportion dies as a result of liver failureQ.MC causes of death in cirrhosis patients: Hepatic failureQ2nd MC causes of death in cirrhosis patients: variceal hemorrhageQ 