CICM SAQ 2011.1 Q2
Question
Answer the following questions about transjugular intrahepatic portosystemic shunts (TIPS):
- a) What is a TIPS procedure and why is it used in patients with portal hypertension?
- b) What are 2 recognised indications for this procedure?
- c) Excluding mortality list 5 COMMON complications of TIPS procedure
- d) Describe one classification system used in assessing severity of chronic liver disease and outline its utility.
Answer
Answer and interpretation
a) What is a TIPS procedure and why is it used in patients with portal hypertension?
The hepatic vein is accessed via the internal jugular vein and IVC. A needle is then passed to connect the hepatic vein with the large portal vein near the centre of the liver, the needle tract dilated and a stent inserted to maintain the tract and form the shunt between the higher pressure portal vein and the lower pressure hepatic vein. This reduces portal hypertension.
b) What are 2 recognised indications for this procedure?
- Variceal bleeding that has failed endoscopic and pharmacological treatment.
- Refractory ascites
c) Excluding mortality list 5 COMMON complications of TIPS procedure
- thrombosis
- occlusion of the stent
- capsular puncture
- bleeding
- encephalopathy
- stent migration
d) Describe one classification system used in assessing severity of chronic liver disease and outline its utility.
Either:
Childs-Pugh score
- Classified A,B or C by a composite of Total bilirubin, albumin, INR, ascites and hepatic encephalopathy. Originally used for prognostication for surgery – also used for prognostication in chronic liver disease and prediction of likelihood of complications of cirrhosis
Or:
- MELD score severity scoring system for assessing severity of chronic liver that uses the serum bilirubin, creatinine and INR. Initially developed to predict three month survival in patients post TIPS. Now used for prognosis of liver disease and prioritizing liver transplant recipients
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
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