Liver Cirrhosis And PHT

1. Liver Cirrhosis AndPHT What is it? • A transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneously created connection within the liver between the portal and systemiccirculations. • It is placed to reduce portal pressure in patients with complications related to portal hypertension. • This procedure has emerged as a less invasive alternative to surgery in patients with end-stage liver disease. • The goal of TIPS placement is to divert portal blood flow into the hepatic vein, so as to reduce the pressure gradient between portal and systemiccirculations. • Shunt patency is maintained by placing an expandable metal stent across the intrahepatictract • Patient has to take lifelong blood thinner in some condition like buddchiarisyndrome. • Why(Indications)? • Acute variceal bleeding that cannot be successfully controlled with medical treatment, includingsclerotherapy. • Recurrent and refractory varicealbleeding • Therapy for refractoryascites. • Portal decompression in patients with hepatic venous outflow obstruction (Budd-Chiari syndrome) or hepatorenal syndrome. Why Not(Contraindication)? • Absolute contraindications: • Right-sided heart failure with increased central venouspressure • Polycystic liverdisease • Relativecontraindications: • Active intra hepatic or systemicinfection • Severe hepatic encephalo-pathy poorly controlled with medicaltherapy • Hyper vascular hepatictumors • P Vthrombosis

2. What you are to do before procedure(Preparation)? • Visit us in OPD (9-5) with previous lab results (*CBC, LFT, Serum Creatinine, PT/INR), imagingetc. • If you are on blood thinner like Aspirin inform duringappointment. • Get admission one day prior to scheduledprocedure. • One accompanyingperson • Need to sign a consent form forprocedure • Cash or ATM card • Approx. Stay inhospital? • We have very fast and competent working team (Consultant, fellow, clinical assistant, technician and ward assistant) which provide you comfortable atmosphere and ease your nerves. Usual time of stay is around 2-3Days. • Complications: • Obstruction toflow • Shunt obstruction(38%) • Hepatic veinstenosis • Trauma • Vascularinjury • Biliaryinjury • Stent dislodgement • Resume towork? • You can resume your work after 1 week if existing diseaseallows. • Results: When and How? • Follow-up Doppler after 3 days, 7 days, 1 month than every 3-6month.