Hepatobiliary and pancreatic surgery: hepatorenal syndrome: 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: hepatorenal syndrome

Sample item

A 52-year-old man with alcoholic cirrhosis and ascites has a creatinine rise from 1.0 to 2.6 mg/dL over a week. Diuretics were stopped and albumin was given for two days without improvement. Urine sodium is low, the sediment is bland and there is no proteinuria or shock. What is the recommended treatment?

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

The answer and the reasoning

A. Terlipressin with intravenous albumin

This is hepatorenal syndrome, a functional renal failure from splanchnic vasodilatation and renal vasoconstriction in advanced cirrhosis. Treatment is a vasoconstrictor such as terlipressin with albumin, and liver transplantation is definitive. Diuretics and nephrotoxins must be avoided.

Option by option

  • A. Terlipressin with intravenous albumin (correct)

    Correct. Vasoconstrictor therapy with albumin is the medical treatment for hepatorenal syndrome.

  • B. Escalating doses of intravenous furosemide

    Diuretics worsen the intravascular depletion and are stopped in this syndrome.

  • C. Large-volume paracentesis without albumin

    Paracentesis without albumin can precipitate circulatory dysfunction and worsen renal function.

  • D. Renal-dose dopamine infusion

    Renal-dose dopamine has no proven benefit in hepatorenal syndrome.

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 A, Terlipressin with intravenous albumin. This is hepatorenal syndrome, a functional renal failure from splanchnic vasodilatation and renal vasoconstriction in advanced cirrhosis.

Why is "Escalating doses of intravenous furosemide" not the answer?

Diuretics worsen the intravascular depletion and are stopped in this syndrome.

Why is "Large-volume paracentesis without albumin" not the answer?

Paracentesis without albumin can precipitate circulatory dysfunction and worsen renal function.

Why is "Renal-dose dopamine infusion" not the answer?

Renal-dose dopamine has no proven benefit in hepatorenal syndrome.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: hepatorenal syndrome in General Surgery. Treatment is a vasoconstrictor such as terlipressin with albumin, and liver transplantation is definitive. Diuretics and nephrotoxins must be avoided.

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: hepatorenal syndrome?

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.