Practical TIPs for #TIPS in @AmCollegeGastro journal summarised here with #Tweetorial style
Indication:
💪Best evidence: Resistant ascites, 2nd prevention of EVB, rescue for EVB
👍Good evidence: Recurrent hydrothorax, Budd-Chiari
❓evidence: HRS
#livertwitter
(1/n)
Indication:
💪Best evidence: Resistant ascites, 2nd prevention of EVB, rescue for EVB
👍Good evidence: Recurrent hydrothorax, Budd-Chiari
❓evidence: HRS
#livertwitter
(1/n)
Contraindication for #TIPS
🛑Absolute: severe HE, severe LF, HF/severe valve insuff, pul HTN, severe PPH, unrelieved bill construction, sepsis
⚠️Relative:⬆️age, hx of HE,⬆️MELD (>15-18),⬆️R/L heart pressure, PPH, extensive HCC/mets, severe coagulopathy/thrombocytopenia
(2/n)
🛑Absolute: severe HE, severe LF, HF/severe valve insuff, pul HTN, severe PPH, unrelieved bill construction, sepsis
⚠️Relative:⬆️age, hx of HE,⬆️MELD (>15-18),⬆️R/L heart pressure, PPH, extensive HCC/mets, severe coagulopathy/thrombocytopenia
(2/n)
Risk for #TIPS
⚡️Liver Failure: precipitating liver shock, ⬇️risk in patients w/ MELD <15-18
⚡️HE: 40% of pt, 1-2 wk or yrs after (⬆️diameter)
📌RF: diameter of TIPS, Hx of HE,⬆️age, sarcopenia, bad liver/renal function
📌Primary ppx is controversial
bit.ly/2BeF1Wl
⚡️Liver Failure: precipitating liver shock, ⬇️risk in patients w/ MELD <15-18
⚡️HE: 40% of pt, 1-2 wk or yrs after (⬆️diameter)
📌RF: diameter of TIPS, Hx of HE,⬆️age, sarcopenia, bad liver/renal function
📌Primary ppx is controversial
bit.ly/2BeF1Wl
