A 25-year-old man from rural Egypt has splenomegaly and esophageal varices. Liver biopsy shows dense fibrous thickening of portal tracts with bridging bands, but hepatocytes are preserved and synthetic liver function remains normal. Portal pressure is elevated. The most likely cause of this presinusoidal portal hypertension is:

• A Alcoholic micronodular cirrhosis
• B Chronic hepatitis B with macronodular cirrhosis
• C Schistosoma mansoni ova deposited in portal venules ✓
• D Primary sclerosing cholangitis with duct obliteration

Explanation

Schistosoma mansoni and S. japonicum eggs lodge in portal venules and incite a granulomatous reaction followed by 'pipestem' periportal fibrosis. Because the fibrosis is presinusoidal, portal hypertension with varices and splenomegaly develops while hepatocytes remain intact and synthetic function is preserved until late. Cirrhosis of any cause destroys the hepatic architecture including hepatocytes and impairs synthetic function earlier, and primary sclerosing cholangitis produces duct-centered concentric fibrosis rather than pure portal tract expansion.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.