Contra indications of portal systemic shunting include-
**Core Concept**
Portal systemic shunting is a surgical procedure used to divert blood flow from the portal vein to the systemic circulation, often to alleviate portal hypertension. This procedure can have significant implications for patients with liver disease, and careful consideration of contraindications is essential to ensure the procedure's success.
**Why the Correct Answer is Right**
The correct answer is **B. Active Variceal Bleeding**. Active variceal bleeding is a contraindication for portal systemic shunting because the procedure can worsen bleeding by increasing portal pressure. Additionally, the presence of active bleeding indicates a high risk of rebleeding post-operatively, making portal systemic shunting a high-risk procedure. This is due to the fact that portal systemic shunting can increase the risk of rebleeding by increasing the pressure in the varices.
**Why Each Wrong Option is Incorrect**
**Option A:** **Severe Liver Dysfunction** is not a contraindication for portal systemic shunting. In fact, patients with severe liver dysfunction may benefit from portal systemic shunting to alleviate portal hypertension.
**Option C:** **Hepatocellular Carcinoma** is not a contraindication for portal systemic shunting. In fact, portal systemic shunting can be used to alleviate symptoms and improve quality of life in patients with hepatocellular carcinoma.
**Clinical Pearl / High-Yield Fact**
Portal systemic shunting is often used as a bridge to liver transplantation in patients with liver disease. However, it is essential to carefully select patients for this procedure to avoid worsening liver function and increasing the risk of complications.
**Correct Answer: B. Active Variceal Bleeding**