What symptom is most indicative of a rupture of varices in a patient with liver disease?

Vomiting bright red blood is the most indicative symptom of a rupture of varices in a patient with liver disease. This occurs due to increased pressure in the portal vein, a condition known as portal hypertension, which can lead to the swelling and ultimate rupture of varices, typically in the esophagus or stomach. When these varices rupture, they can bleed profusely, and the blood is typically fresh due to its proximity to the point of rupture in the upper gastrointestinal tract. This results in the characteristic symptom of hematemesis, or vomiting of bright red blood, which is a critical and urgent sign that requires immediate medical attention.

Other symptoms, while they may be present in patients with liver disease or gastrointestinal bleeding, do not specifically indicate a rupture of varices. For example, severe dysphagia (difficulty swallowing) and abdominal pain are not directly related to variceal rupture and can be caused by a variety of other conditions. Elevated blood pressure is not typically associated with variceal bleeding but may instead reflect the underlying liver disease and portal hypertension without directly indicating an active bleed. Thus, the symptom of vomiting bright red blood is crucial in identifying a rupture of varices and guiding emergency treatment.