Which finding indicates liver shunt failure?

Which finding indicates liver shunt failure?

• A. Recanalization of the umbilical vein
• B. Decreased ascites
• C. Decreased variceal bleeding
• D. Dilation of the hepatic artery

Answer: (A)

The key idea is that a surgically placed liver shunt is meant to lower portal venous pressure by diverting blood away from the portal system. When the shunt isn’t functioning adequately, portal hypertension persists, and the body develops collateral pathways to decompress the portal system. Recanalization of the umbilical vein is a classic collateral channel that opens up in response to elevated portal pressure, signaling that the shunt is not effectively reducing the pressure. On ultrasound, you’d see a dilated paraumbilical (umbilical) vein coursing along the ligamentum teres, which indicates shunt failure. Decreased ascites or decreased variceal bleeding would actually suggest improved portal pressure and shunt effectiveness, not failure. Dilation of the hepatic artery can occur for various reasons and is not a specific marker of shunt failure.

The key idea is that a surgically placed liver shunt is meant to lower portal venous pressure by diverting blood away from the portal system. When the shunt isn’t functioning adequately, portal hypertension persists, and the body develops collateral pathways to decompress the portal system. Recanalization of the umbilical vein is a classic collateral channel that opens up in response to elevated portal pressure, signaling that the shunt is not effectively reducing the pressure. On ultrasound, you’d see a dilated paraumbilical (umbilical) vein coursing along the ligamentum teres, which indicates shunt failure.

Decreased ascites or decreased variceal bleeding would actually suggest improved portal pressure and shunt effectiveness, not failure. Dilation of the hepatic artery can occur for various reasons and is not a specific marker of shunt failure.