Biliary: haemobilia: 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 · Biliary: haemobilia

Sample item

Two days after a percutaneous transhepatic biliary drainage, a 55-year-old man develops right upper quadrant colic, new jaundice and melaena, with blood seen draining through the tube. He is haemodynamically stable and the haemoglobin has fallen by 2 g/dL. What is the best next step?

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

The answer and the reasoning

B. Hepatic angiography with selective arterial embolisation

Haemobilia is bleeding into the biliary tree, most often from iatrogenic injury (liver biopsy, biliary drainage) or trauma, and produces Quincke triad of biliary colic, jaundice and gastrointestinal bleeding. Hepatic angiography identifies a pseudoaneurysm or arteriovenous fistula, and selective embolisation controls the bleeding in most cases. Surgery is reserved for embolisation failure.

Option by option

  • A. Immediate right hepatectomy

    Hepatectomy is excessive major surgery and is kept for failure of embolisation.

  • B. Hepatic angiography with selective arterial embolisation (correct)

    Correct. Angiographic embolisation of the bleeding hepatic arterial branch is first-line treatment.

  • C. Repeat endoscopic variceal band ligation

    Variceal ligation treats portal hypertensive bleeding, and this bleeding follows a procedural arterial injury.

  • D. Oral vitamin K alone and observation

    Vitamin K corrects a coagulopathy and does not treat a pseudoaneurysm that is actively bleeding into the duct.

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 B, Hepatic angiography with selective arterial embolisation. Haemobilia is bleeding into the biliary tree, most often from iatrogenic injury (liver biopsy, biliary drainage) or trauma, and produces Quincke triad of biliary colic, jaundice and gastrointestinal bleeding.

Why is "Immediate right hepatectomy" not the answer?

Hepatectomy is excessive major surgery and is kept for failure of embolisation.

Why is "Repeat endoscopic variceal band ligation" not the answer?

Variceal ligation treats portal hypertensive bleeding, and this bleeding follows a procedural arterial injury.

Why is "Oral vitamin K alone and observation" not the answer?

Vitamin K corrects a coagulopathy and does not treat a pseudoaneurysm that is actively bleeding into the duct.

What concept does this question test?

It tests Biliary: haemobilia in General Surgery. Hepatic angiography identifies a pseudoaneurysm or arteriovenous fistula, and selective embolisation controls the bleeding in most cases. Surgery is reserved for embolisation failure.

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 Biliary: haemobilia?

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.