A 63 year old male who is known to be
hepatitis B positive is admitted with a history of abdominal discomfort and
distension. Apart from infection with hepatitis B the patient had no
significant past illnesses. He was not on any drugs.
On examination he was deeply
jaundiced, there were multiple spider naevi on his upper chest, there was
palmar erythema and he had a flapping tremor.
Examination of his abdomen revealed
hepatomegaly 4 fingerbreadths, there was a hepatic bruit and he had
Hb 12.5 g/dL
WBC 7.2 x109/L
Bilirubin 300 Ámol/L
ALT 400 U/L
ALP 350 U/L
Albumin 32 g/L
In this patient which one of the
following is the most likely cause of the deterioration in his condition?
Bleeding oesophageal varices