Portal hypertension: refractory variceal bleeding: 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 · Portal hypertension: refractory variceal bleeding

Sample item

A 48-year-old cirrhotic man with acute oesophageal variceal haemorrhage continues to bleed despite terlipressin, prophylactic antibiotics and two sessions of endoscopic band ligation. He is resuscitated and intubated. What is the most appropriate next intervention?

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

The answer and the reasoning

A. Rescue transjugular intrahepatic portosystemic shunt

Bleeding that persists despite combined pharmacological and endoscopic therapy is refractory variceal bleeding. A balloon tamponade tube can bridge briefly, but rescue TIPS decompresses the portal system and is the recommended definitive rescue. Surgical shunts are reserved for selected patients when TIPS is unavailable.

Option by option

  • A. Rescue transjugular intrahepatic portosystemic shunt (correct)

    Correct. Rescue TIPS lowers portal pressure and controls refractory bleeding.

  • B. Repeat the same band ligation indefinitely

    Repeating a failed modality without lowering portal pressure is unlikely to stop the bleed.

  • C. Increase oral propranolol dose

    Oral beta-blockers are used for secondary prophylaxis, not for acute uncontrolled haemorrhage.

  • D. Oesophagectomy

    Oesophagectomy is a major operation with prohibitive mortality in a cirrhotic bleeding patient.

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.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Rescue transjugular intrahepatic portosystemic shunt. Bleeding that persists despite combined pharmacological and endoscopic therapy is refractory variceal bleeding.

Why is "Repeat the same band ligation indefinitely" not the answer?

Repeating a failed modality without lowering portal pressure is unlikely to stop the bleed.

Why is "Increase oral propranolol dose" not the answer?

Oral beta-blockers are used for secondary prophylaxis, not for acute uncontrolled haemorrhage.

Why is "Oesophagectomy" not the answer?

Oesophagectomy is a major operation with prohibitive mortality in a cirrhotic bleeding patient.

What concept does this question test?

It tests Portal hypertension: refractory variceal bleeding in General Surgery. A balloon tamponade tube can bridge briefly, but rescue TIPS decompresses the portal system and is the recommended definitive rescue. Surgical shunts are reserved for selected patients when TIPS is unavailable.

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 Portal hypertension: refractory variceal bleeding?

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.