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Schistosomal vs Cirrhotic Portal HTN — SCE Infectious Diseases MCQ

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HardParasitologySchistosomal vs Cirrhotic Portal HTNSCE Infectious Diseases

A patient with hepatosplenic Schistosoma mansoni infection has severe oesophageal varices but normal albumin and INR. Why can hepatic synthetic function remain preserved?

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Correct answer: E — The portal hypertension is predominantly presinusoidal from periportal fibrosis rather than hepatocyte failure

The best answer is “The portal hypertension is predominantly presinusoidal from periportal fibrosis rather than hepatocyte failure”. Egg-driven periportal fibrosis obstructs portal flow upstream of sinusoids while much of the parenchyma remains functional, unlike advanced cirrhosis. Chronic intestinal schistosomiasis can cause presinusoidal periportal fibrosis and portal hypertension while hepatocellular synthetic function remains relatively preserved.

Reference: WHO schistosomiasis fact sheet: https://www.who.int/news-room/fact-sheets/detail/schistosomiasis