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Portal Hypertension Splenomegaly — RACP Adult Medicine MCQ

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EasyGastroenterologyPortal Hypertension SplenomegalyRACP Adult Medicine

A 45-year-old man with alcoholic cirrhosis presents with massive splenomegaly, ascites, and pancytopenia. Platelet count is 55 × 10⁹/L. There are no abnormal cells on blood film. Liver biopsy confirms cirrhosis with portal hypertension. Doppler ultrasound shows splenomegaly with portal venous flow reversal. What is the most likely cause of splenomegaly?

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Correct answer: D — Portal hypertension

Splenomegaly with ascites, pancytopenia (hypersplenism), and portal venous flow reversal on Doppler in cirrhosis is congestive splenomegaly from portal hypertension. The pancytopenia results from splenic sequestration (hypersplenism). Treatment addresses the underlying portal hypertension. Platelet count <50 increases bleeding risk during procedures.

Reference: GESA – 2024 – Cirrhosis; EASL 2024