Hepatobiliary and pancreatic surgery: surgery in portal hypertension: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hepatobiliary and pancreatic surgery: surgery in portal hypertension

Sample item

A Child A cirrhotic patient has recurrent variceal bleeding despite beta-blockers and band ligation. Which procedure selectively decompresses the varices while preserving portal flow to the liver?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Distal splenorenal (Warren) shunt

The distal splenorenal shunt decompresses gastro-oesophageal varices via the short gastric veins and spleen to the left renal vein while maintaining portal perfusion, so encephalopathy is less than with total shunts. TIPS is used as a bridge or alternative.

Option by option

  • A. Total gastrectomy

    Gastrectomy does not treat varices.

  • B. Mesocaval H-graft with large diameter

    Large-diameter H-graft is a nonselective shunt.

  • C. Distal splenorenal (Warren) shunt (correct)

    Correct. This selective shunt reduces encephalopathy.

  • D. Portacaval end-to-side shunt

    End-to-side portacaval shunt is a total shunt.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Distal splenorenal (Warren) shunt. The distal splenorenal shunt decompresses gastro-oesophageal varices via the short gastric veins and spleen to the left renal vein while maintaining portal perfusion, so encephalopathy is less than with total shunts.

Why is "Total gastrectomy" not the answer?

Gastrectomy does not treat varices.

Why is "Mesocaval H-graft with large diameter" not the answer?

Large-diameter H-graft is a nonselective shunt.

Why is "Portacaval end-to-side shunt" not the answer?

End-to-side portacaval shunt is a total shunt.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: surgery in portal hypertension in General Surgery. TIPS is used as a bridge or alternative.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary and pancreatic surgery: surgery in portal hypertension?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.