Sutures and Wound Repair/ General Surgery (ABSA) Practice Test

What is the primary indication for a portacaval shunt?

1. Hepatic failure

2. Esophageal varices

3. Cirrhosis

4. Portal hypertension

The correct answer is: Esophageal varices

The primary indication for a portacaval shunt is portal hypertension. This condition arises when there is increased pressure in the portal venous system, often due to liver cirrhosis or other liver diseases that obstruct blood flow. The portacaval shunt is a surgical procedure that creates a connection between the portal vein and the inferior vena cava, allowing blood to bypass the liver and reduce the pressure in the portal system. While esophageal varices, which are dilated veins in the esophagus that can rupture and cause bleeding, often develop as a consequence of portal hypertension, the shunt's main purpose is to directly address the underlying increased pressure in the portal circulation rather than to treat the varices themselves. Cirrhosis and hepatic failure are related conditions and may contribute to the development of portal hypertension but are not the primary reason for performing the shunt. The shunt specifically aims to alleviate the complications arising from elevated portal pressure, such as variceal bleeding, by providing an alternate pathway for blood flow. Therefore, selecting portal hypertension as the primary indication reflects a deeper understanding of the condition that necessitates such a surgical intervention.