Portal Hypertension — Surgical

A patient presents with the abdominal findings shown in the image. The dilated and tortuous superficial veins radiating from the periumbilical region are most indicative of which of the following conditions?

A 52-year-old man with alcohol-related cirrhosis (Child-Pugh Class B) and portal hypertension is referred for elective surgical management of recurrent esophageal variceal bleeding controlled by endoscopic therapy. He has no ascites, normal renal function, and normal hepatic synthetic function. Duplex ultrasound confirms patent portal vein and splenic vein. Endoscopy shows large varices with red-wale signs. His wife is concerned about postoperative encephalopathy. Which shunt procedure would be most appropriate for this patient?

A 48-year-old man with cirrhosis (Child-Pugh Class C) presents with hematemesis and melena. Upper endoscopy confirms bleeding esophageal varices. After initial resuscitation and variceal ligation, he remains hemodynamically unstable with recurrent bleeding despite 2 units of packed RBCs and octreotide infusion. His wife asks about definitive surgical options. Which of the following procedures would be most appropriate for this patient given his clinical status and liver function?

A 48-year-old man with a 15-year history of alcohol-related cirrhosis presents to the emergency department with a 2-day history of haematemesis and melaena. On examination, he is haemodynamically unstable (BP 85/50, HR 118/min), with clinical signs of portal hypertension including splenomegaly and ascites. Upper endoscopy confirms actively bleeding oesophageal varices. After 2 units of packed RBCs and fresh frozen plasma, variceal bleeding is controlled endoscopically with band ligation. However, 48 hours later, he re-bleeds. Repeat endoscopy fails to control the bleeding. What is the most appropriate next step in management?

A 52-year-old woman with hepatitis B-related cirrhosis and known portal hypertension is admitted with a 6-hour history of sudden-onset haematemesis (approximately 500 mL of fresh blood) and haemodynamic instability (BP 88/55, HR 125/min). She is resuscitated with 2 units of packed RBCs and started on octreotide and ceftriaxone. Upper endoscopy is performed urgently and shows actively bleeding oesophageal varices, which are successfully band-ligated. Repeat endoscopy at 24 hours shows no active bleeding. She remains haemodynamically stable and tolerating oral intake. What is the most appropriate long-term management to prevent variceal rebleeding?