A 49-year-old homeless man is admitted to hospital with melaena.
He has a history of alcohol excess and hepatitis C.
Physical examination reveals mild tenderness in the epigastrium. An upper GI endoscopy is performed a picture from which is shown below.
What is the underlying diagnosis?
Dieulafoy’s lesion
Duodenal ulceration
Gastritis
Mallory-Weiss tear
Oesophageal varices
Explanation:
The endoscopic appearances are of a reasonably sized duodenal ulcer (A) with evidence of recent haemorrhage and a visible vessel. There is some co-existent duodenitis. The presence of villi identifies this as the duodenum.
The mucosal appearances are not consistent with that of the stomach (absence of rugae, paler squamous epithelium rather than redder columnar epithelium) or the oesophagus (pale pink non-villous squamous epithelium).