A 56-year-old man with a history of heavy alcohol consumption is admitted with sudden massive hematemesis and hypotension. On examination there is jaundice, spider angiomata, abdominal distension with shifting dullness, and edema.Select the most likely cause of gastrointestinal blood loss

Esophageal varices due to portal hypertension usually bleed without warning or preceding pain. Patients frequently have stigmata of cirrhosis (jaundice and spider angiomata) and portal hypertension (ascites and edema). Blood loss in both Mallory-Weiss tears and esophageal varices can be massive. Hereditary hemorrhagic telangiectasia or Osler-Weber-Rendu syndrome is a cause of nosebleeds, mild GI bleeding, and cutaneous or mucosal telangiectasias. Associated arteriovenous malformations can appear in the brain, lungs, liver, and intestine.