The preferred Shunt procedure for the patient with portal hypertension having acceptable operative risk and adequate liver function is
**Core Concept**
The question is testing the knowledge of shunt procedures in the management of portal hypertension. The preferred shunt procedure is one that balances the reduction of portal pressure with the preservation of hepatic blood flow, minimizing the risk of encephalopathy and liver failure.
**Why the Correct Answer is Right**
The correct answer is the selective or non-selective shunt that aims to reduce portal pressure while maintaining adequate hepatic blood flow. The selective shunt, specifically the selective mesocaval shunt, involves the creation of a shunt between the superior mesenteric vein and the inferior vena cava, reducing the portal pressure without compromising hepatic blood flow. This is particularly useful in patients with acceptable operative risk and adequate liver function.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect as it refers to a non-selective shunt that may reduce portal pressure but can compromise hepatic blood flow, leading to liver failure.
* **Option B:** This option is incorrect as it is a surgical procedure that is not commonly used for portal hypertension.
**Clinical Pearl / High-Yield Fact**
A key consideration in choosing the right shunt procedure is the patient's liver function and operative risk. A selective shunt like the selective mesocaval shunt is preferred in patients with acceptable operative risk and adequate liver function.
**Correct Answer: C. Selective mesocaval shunt**