Esophageal varices are almost always caused by which hepatobiliary condition?

• A. Hypotension
• B. Portal hypertension
• C. Hypoxia
• D. Renal failure

Answer: (B)

Esophageal varices form from increased pressure in the portal venous system, a situation called portal hypertension. When the liver is chronically diseased—most often due to cirrhosis from long-term alcohol use or hepatitis—the resistance to portal blood flow rises. To bypass this high pressure, blood is shunted through collateral veins, including the esophageal submucosal veins, which dilate into varices. These varices are fragile and can rupture, leading to potentially life-threatening bleeding. Therefore, the hepatobiliary condition most commonly responsible is portal hypertension from liver disease. Other conditions like low blood pressure, low oxygen, or kidney failure do not cause the same portal-systemic pressure changes that create esophageal varices.