Abdominal and GI imaging: portal venous flow reversal: practice question

A Radiology 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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Radiology · Abdominal and GI imaging: portal venous flow reversal

Sample item

A cirrhotic patient with ascites and varices undergoes Doppler of the main portal vein. Which finding reflects severe portal hypertension?

AFlow toward the liver with respiratory variationBAbsent flow with a cavernous collateral networkCMarkedly pulsatile flowDFlow directed away from the liver

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

The answer and the reasoning

D. Flow directed away from the liver

Normally portal flow is hepatopetal. In advanced portal hypertension the resistance of the cirrhotic liver may exceed that of the collaterals, so flow reverses and becomes hepatofugal. Doppler is the first-line test for the portal vein.

Option by option

A. Flow toward the liver with respiratory variation
Hepatopetal flow with respiratory variation is the normal pattern.
B. Absent flow with a cavernous collateral network
Absent flow with cavernous transformation indicates chronic portal vein thrombosis, a separate cause.
C. Markedly pulsatile flow
Marked pulsatility suggests right heart failure or tricuspid regurgitation.
D. Flow directed away from the liver (correct)
Correct. Reversed, hepatofugal flow marks severe portal hypertension.

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.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Flow directed away from the liver. Normally portal flow is hepatopetal.

Why is "Flow toward the liver with respiratory variation" not the answer?

Hepatopetal flow with respiratory variation is the normal pattern.

Why is "Absent flow with a cavernous collateral network" not the answer?

Absent flow with cavernous transformation indicates chronic portal vein thrombosis, a separate cause.

Why is "Markedly pulsatile flow" not the answer?

Marked pulsatility suggests right heart failure or tricuspid regurgitation.

What concept does this question test?

It tests Abdominal and GI imaging: portal venous flow reversal in Radiology. In advanced portal hypertension the resistance of the cirrhotic liver may exceed that of the collaterals, so flow reverses and becomes hepatofugal. Doppler is the first-line test for the portal vein.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Abdominal and GI imaging: portal venous flow reversal?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.