Hepatobiliary and pancreatic surgery: sinistral 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: sinistral portal hypertension

Sample item

A man with a history of chronic pancreatitis has isolated gastric fundal varices with no oesophageal varices. Liver function is normal and he has splenomegaly. What are the likely cause and definitive treatment?

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

The answer and the reasoning

B. Splenic vein thrombosis; splenectomy

Inflammation around the pancreas can thrombose the splenic vein, causing left-sided or sinistral portal hypertension. Blood drains through the short gastric veins, producing isolated gastric fundal varices and splenomegaly with a normal liver. Splenectomy removes the venous drainage route and cures the problem.

Option by option

  • A. Hepatic vein thrombosis; hepatic vein stenting

    Hepatic vein thrombosis is Budd-Chiari syndrome, which presents with ascites and hepatomegaly.

  • B. Splenic vein thrombosis; splenectomy (correct)

    Correct. Splenic vein thrombosis from pancreatic disease is cured by splenectomy.

  • C. Portal vein thrombosis; TIPS

    Portal vein thrombosis would cause oesophageal varices as well and is treated differently.

  • D. Cirrhosis; liver transplantation

    Cirrhosis would show abnormal liver function and oesophageal varices.

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 B, Splenic vein thrombosis; splenectomy. Inflammation around the pancreas can thrombose the splenic vein, causing left-sided or sinistral portal hypertension.

Why is "Hepatic vein thrombosis; hepatic vein stenting" not the answer?

Hepatic vein thrombosis is Budd-Chiari syndrome, which presents with ascites and hepatomegaly.

Why is "Portal vein thrombosis; TIPS" not the answer?

Portal vein thrombosis would cause oesophageal varices as well and is treated differently.

Why is "Cirrhosis; liver transplantation" not the answer?

Cirrhosis would show abnormal liver function and oesophageal varices.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: sinistral portal hypertension in General Surgery. Blood drains through the short gastric veins, producing isolated gastric fundal varices and splenomegaly with a normal liver. Splenectomy removes the venous drainage route and cures the problem.

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: sinistral 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.