Rosh Emergency Medicine Practice Test

What might heavy alcohol use leading to retching indicate in emergency department presentations?

1. Chronic nausea

2. Hematemesis

3. Gastroesophageal reflux

4. Esophageal varices

The correct answer is: Hematemesis

Heavy alcohol use can lead to a variety of gastrointestinal issues, and in the context of retching, it is particularly significant when considering the possibility of hematemesis, which is the vomiting of blood. This can occur due to several factors related to alcohol abuse. Firstly, chronic alcohol consumption can cause mucosal irritation and damage to the lining of the stomach and esophagus. This irritation can lead to the development of gastric or esophageal ulcers, which may bleed, resulting in hematemesis. The retching often seen in heavy drinkers can exacerbate this condition by increasing intra-abdominal pressure, potentially leading to rupture of these lesions. Additionally, individuals with heavy alcohol use may develop liver disease, which could lead to portal hypertension and subsequently cause esophageal varices. While esophageal varices can lead to hematemesis through significant bleeding, the presence of retching specifically indicates irritation or injury to the upper gastrointestinal tract rather than a mechanical issue related to varices alone. In this context, retching in a person with heavy alcohol use typically raises the suspicion of hematemesis due to the mechanisms of mucosal injury, ulceration, or other forms of gastrointestinal bleeding related to the effects of alcohol on the digestive system.