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Schistosomal Portal Hypertension — SCE Infectious Diseases MCQ

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ModerateParasitologySchistosomal Portal HypertensionSCE Infectious Diseases

A 40-year-old woman with known schistosomiasis (S. mansoni) develops portal hypertension with oesophageal varices. She has normal synthetic liver function (albumin 42, INR 1.0). What type of portal hypertension does hepatic schistosomiasis cause?

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Correct answer: D — Pre-sinusoidal portal hypertension (periportal fibrosis occluding portal venules — hepatocyte function preserved)

Hepatic schistosomiasis (S. mansoni/japonicum) causes pre-sinusoidal portal hypertension through periportal (Symmers pipe-stem) fibrosis. This is fundamentally different from cirrhosis: the periportal fibrosis obstructs portal venules, causing portal hypertension and variceal formation, but the hepatocytes and hepatic sinusoids are relatively preserved. Therefore, liver synthetic function (albumin, coagulation) remains normal until very late disease. This distinction has important clinical implications — these patients tolerate variceal bleeding better than cirrhotic patients.

Reference: WHO 2022 – Schistosomiasis; EASL 2024 – Portal hypertension