What primary condition is suspected with moderate anemia, ascites, hemorrhoids, and esophageal varices on endoscopy?

• A. Portal hypertension
• B. Iron deficiency anemia
• C. Peptic ulcer disease
• D. Esophagitis

Answer: (A)

Portal hypertension is the key idea here. Esophageal varices arise when there is increased pressure in the portal venous system, and ascites reflects fluid that leaks out of the high-pressure portal system into the peritoneal cavity. Hemorrhoids can also enlarge as part of the portal-systemic collateral circulation that develops in this setting. So the combination of ascites and esophageal varices on endoscopy points to portal hypertension, often due to liver disease such as cirrhosis, with anemia that can be from chronic liver disease or variceal bleeding. Iron deficiency anemia would not explain the ascites and varices; peptic ulcer disease can cause anemia but not the ascites or varices; esophagitis does not account for the ascites or variceal formation.