Gastroenterology and hepatology: sinistral portal hypertension: practice question

A General Medicine 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 Medicine · Gastroenterology and hepatology: sinistral portal hypertension

Sample item

A 45-year-old man with chronic pancreatitis has haematemesis. Endoscopy shows isolated fundal gastric varices with no oesophageal varices. The liver looks normal on CT, but the spleen is enlarged. Which vessel is most likely occluded?

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

The answer and the reasoning

A. Splenic vein

Inflammation of the pancreas can thrombose the adjacent splenic vein. Blood from the spleen and stomach then drains through the short gastric veins, producing isolated gastric varices and splenomegaly with a normal liver. Splenectomy cures the condition.

Option by option

  • A. Splenic vein (correct)

    Correct. Splenic vein thrombosis causes left-sided portal hypertension with isolated gastric varices.

  • B. Main portal vein

    Main portal vein occlusion causes oesophageal varices as well as gastric varices.

  • C. Hepatic veins

    Hepatic vein occlusion causes Budd-Chiari syndrome with ascites and a congested liver.

  • D. Superior mesenteric vein

    Superior mesenteric vein thrombosis causes bowel ischaemia rather than isolated gastric 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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Splenic vein. Inflammation of the pancreas can thrombose the adjacent splenic vein.

Why is "Main portal vein" not the answer?

Main portal vein occlusion causes oesophageal varices as well as gastric varices.

Why is "Hepatic veins" not the answer?

Hepatic vein occlusion causes Budd-Chiari syndrome with ascites and a congested liver.

Why is "Superior mesenteric vein" not the answer?

Superior mesenteric vein thrombosis causes bowel ischaemia rather than isolated gastric varices.

What concept does this question test?

It tests Gastroenterology and hepatology: sinistral portal hypertension in General Medicine. Blood from the spleen and stomach then drains through the short gastric veins, producing isolated gastric varices and splenomegaly with a normal liver. Splenectomy cures the condition.

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 Gastroenterology and hepatology: sinistral portal hypertension?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.