Hemorrhoids can occur with portal hypertension.

• A. Portal hypertension
• B. Liver cirrhosis
• C. Esophageal varices
• D. Caput Medusa

Answer: (A)

Hemorrhoids arise when venous channels in the anorectal region become engorged due to increased venous pressure. In portal hypertension, the portal venous system is under higher pressure, so blood is shunted through portosystemic collateral pathways. The superior rectal vein (portal) communicates with the middle and inferior rectal veins (systemic). When portal pressure rises, these anorectal veins dilate, forming hemorrhoidal varices. That’s why hemorrhoids can occur in the setting of portal hypertension.

Other sites like esophageal varices and caput medusae are also collateral pathways in portal hypertension, but they’re not hemorrhoids. Liver cirrhosis can cause portal hypertension, but the question focuses on the state that explains hemorrhoid formation, which is the portal hypertension itself.