This 73 year old man has been drinking alcohol for many years. He stopped drinking 1 week before he came to the hospital where he was admitted with yellow jaundice. This was due to liver failure from years of drinking. He eventually developed cirrhosis of the liver and jaundice. While in the hosptial, he began to vomit large amounts of fresh red blood. He was transferred to the Intensive Care Unit where he was given 4 units of blood in the first hour just to keep his blood pressure near normal. We were asked to perform an emergency gastroscopy "scope" test to determine the cause of bleeding.
A gastroscopy exam revealed that the bleeding was coming from varices - swollen varicose veins in his esophagus caused by long standing cirrhosis of the liver. During the exam, you could see fresh red blood spurting out with every heartbeat - as seen in the photo taken above.
Often varices will rupture and hemorrhage as in this case - sometimes massively. Through the gastroscope, we injected the bleeding site with clotting factors and stopped the bleeding. Then he was placed in medications by vein to help prevent rebleeding. The scope test saved his life but sadly his liver is so badly damaged that his long term survival is unlikley.