A male with Recurrent UGI Bleed

52/female brought to casualty in drowsy state with c/o progressively increasing jaundice since 2 months for which they were taking some ayurvedic medicines from a quack.  pt is non alcoholic, no h/o blood transfusion, fever, no h/o significant weight loss.  o/e- drowsy, pulse- 110/min, BP- 90/60. spo2 98% on air. icterus, pallor and pedal edema present.  P/A- liver palpable 4 cms and free fluid present.  within 1 hour of admission she started with profuse malena and hematemesis.  Ix showed Hb (6.8), TLC (10,300), Plt (4.17L), Total Bil (18), direct (10) indirect (8), OT/PT (265/121), Albumin (3.5),Globulin (3.1), serum ammonia 250, HBSAg, HCV negative, INR (1.8), Urea (46), creat (1.9), Na (145), K (2.9).  Diagnostic Ascitic tap was done and report attached (ADA and cytology awaited). USG and CT abdomen attached.  could it be malignancy?  can obstructive jaundice present directly at this terminal stage? patient had no h/o abdominal pains before and had no h/o gall stones.  Budd Chiari? 

70 year old farmer admitted in the general ward since the past 2 days for complains of pain abdomen and fatigue was awaiting his investigation reports when he had his 1st episode of hematemesis following which he had convulsions and passed out. Sever pallor BP 140/80 Pulse 88/ min Grade 3 clubbing Possibilities ?

4 yr old male with H/O vomiting red blood twice,fever, decreased urination ,black coloured stools and RTI since 1day O/E pulse 120/min facial puffiness +ve Chest:clear P/A: soft,bowel sounds normal pic of face and vomit attached herewith

60 year old lady with hematemesis Hypotension and gross pallor Resuscitation done Background cad on ecosprin Scopy done

22 year old active unmarried female patient came with complaints of cough which is immediately followed by vomiting for past two days . the vomiting content posted in the pictures.. on examination pallor, BP 90/60, cvs normal, rs no crepts, no wheeze, abdomen epigastric tenderness present.. working in a corporate company.. daily skips breakfast and supper for past two months.. Wat are the basic investigation to be done.. Wat is the management..