{"ops":[{"insert":"A 30-year-old man presents with mild epigastric pain for around a month, which worsens following meals, and is associated with post-prandial nausea.\n\nClose questioning reveals the passage of black, tarry, foul-smelling stools twice in a single day, around 3 days ago. His bowel habits are unchanged from earlier, and there is no history of recent trauma or bleeding disorders.\n\nHis medical, surgical, and family histories are unremarkable. He does not smoke, but has been consuming an estimated 3 to 5 units of alcohol each week for over a decade now.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-104_en.png"}},{"insert":"\n"}]}
2
Investigate
Upper GI Endoscopy
{"ops":[{"insert":"Endoscopy of the distal esophagus reveals nonbleeding grade II-III varices in the 1 o\u0027clock, 5 o\u0027clock, and 9 o\u0027clock positions.\n"}]}
Abdominal Ultrasound
{"ops":[{"insert":"The liver parenchyma appears normal. Moderate splenomegaly is present. There is increased periportal echogenicity, with multiple echogenic structures within the portal vein. Doppler scanning confirms partial obliteration of the lumen of portal vein, with hepatofugal flow.\n"}]}