Hepatobiliary Disease USMLE Step 1 Practice Question
A 45-year-old man presents to the emergency department with 3 days of bright red blood per rectum. He denies abdominal pain or pain with bowel movements. He has a history of alcohol use disorder and was hospitalized 18 months ago with variceal upper gastrointestinal bleeding, after which he was diagnosed with cirrhosis. He reports ongoing alcohol consumption despite counseling. Vital signs show blood pressure 110/70 mmHg and heart rate 92/min. On examination, he has scleral icterus, mild lower extremity edema, and a palpable fluid wave. Anoscopy demonstrates enlarged, bluish submucosal vessels located proximal to the dentate line. Which of the following best explains the venous drainage pathway of these bleeding vessels?
Answer choices
- ASuperior rectal veins → inferior mesenteric vein → portal veinCorrect answer
- BInferior rectal veins → internal pudendal vein → internal iliac vein
- CMiddle rectal veins → internal iliac vein → portal vein
- DSuperior rectal arteries → superior mesenteric artery → hepatic artery
- EInferior mesenteric veins → splenic vein → hepatic vein
- FInternal hemorrhoidal plexus → inferior vena cava → right atrium
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