Mallory-Weiss syndrome Quiz: Ace Your Exams

A 54-year-old woman comes to the emergency department for evaluation of vomiting, watery diarrhea, and fever for the past 24 hours. Over the past day, the patient states she has had 10-12 episodes of forceful vomiting with clear emesis; however, for the last two hours, she has noticed bright red blood in the vomitus. She reports crampy abdominal pain. The patient’s medical history is significant for hypertension, hiatal hernia, and knee osteoarthritis. She takes lisinopril, omeprazole, and occasionally naproxen. She does not smoke cigarettes or drink alcohol. She works at a daycare. Temperature is 38.1°C (100.6°F), pulse is 105/min, blood pressure is 100/58 mmHg, and respirations are 18/min. Her conjunctiva are pale. Cardiopulmonary exam is significant for tachycardia and normal heart sounds. Abdominal examination shows mild diffuse abdominal tenderness without rebound or guarding. Rectal examination shows normal tone with heme-negative watery stool. Which of the following is most likely to be seen on upper endoscopy?