A 66-year-old man with alcoholic cirrhosis on anticoagulation for atrial fibrillation was admitted with anemia, melena, hypotension, dehydration, and acute renal failure. Labs showed coagulopathy and hypoperfusion. Urgent gastroscopy revealed superficial longitudinal gastric ulcers from the upper body to prepyloric region, without active bleeding or portal hypertension. Biopsies excluded infection and other causes. Findings were consistent with ischemic gastropathy, likely due to systemic hypoperfusion and cirrhosis. Endoscopic features include erythematous, congested mucosa with superficial ulceration. Early endoscopic recognition is essential for accurate diagnosis and management, preventing misdiagnosis in cirrhotic patients presenting with upper gastrointestinal bleeding.