What is TIPS (transjugular intrahepatic portosystemic shunt)?
Transjugular intrahepatic portosystemic shunt or (TIPS) is a shunt (tube) placed between the portal vein which carries blood from the intestines and intraabdominal organs to the liver and the hepatic vein which carries blood from the liver back to the vena cava and the heart.
What is TIPS used for?
It is used primarily (but not exclusively) in patients with cirrhosis in which the scar tissue within the liver causes partial blockage of flow of blood passing through the liver from the portal vein to the hepatic vein. The blockage increases the pressure in the portal vein, which is called portal hypertension. As a result of the increase in pressure, portal blood flows preferentially or shunts through the branches of the portal vein to veins coming from abdominal organs that normally drain toward the portal vein. These organs connect with veins that do not empty into the portal vein and thus bypass the liver. Thus, much of the flow of blood bypasses the liver. If these veins going to the other organs enlarge, they are referred to as variceal veins or varices. Unfortunately, one of the places varices form is in the stomach and lower esophagus, and these varices have a tendency to bleed massively, frequently causing death from exsanguination. By providing an artificial path for blood traveling from the intestines, through, the liver, and back to the heart, the shunt placed during the TIPS procedure reduces the pressure in the portal vein, significantly decreasing the likelihood of varices bleeding.
How is TIPS performed?
There are several types of portosystemic shunts that are placed surgically, but TIPS is a non-surgical method of placing a portosystemic shunt. The shunt is passed down the jugular vein from the neck by a radiologist using X-ray guidance. The shunt then is inserted between the portal and hepatic veins within the liver.
What are the complications of TIPS?
There are two important complications of the TIPS procedure. The first is hepatic encephalopathy, a condition in which it is believed that toxic products from the intestines (for example, ammonia) that are normally removed from the blood by the liver remain in the blood and are delivered to the brain. (The TIPS allows the toxin-containing blood to bypass the liver.) The effects on the brain can vary from minor alterations in thinking to full coma.
A second complication is heart failure due to the sudden increase in the amount of blood returning to the heart through the shunt. The heart is unable to pump the returning blood fast enough, resulting in heart failure.
Finally, one complication may be caused by the shunt itself; problems such as infection and shunt occlusion, requiring placement of another shunt.
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Bleeding VaricesVarices are dilated blood vessels usually in the esophagus or stomach. Symptoms of bleeding varices include vomiting blood, black stools, low blood pressure, shock, and rapid heart rate. Bleeding varices are a medical emergency. Treatment may involve liver transplant, devascularization, distal splenorenal shunt, banding, sclerotherapy, or transjugular intrahepatic protosystemic shunt.
Cirrhosis (Liver)Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.
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Liver DiseaseLiver disease can be cause by a variety of things including infection (hepatitis), diseases, for example, gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause and may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
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Portal HypertensionPortal hypertension is most commonly caused by cirrhosis, a disease that results from scarring of the liver. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, and a parasitic infection called schistosomiasis. Symptoms of portal hypertension include varices (enlarged veins), vomiting blood, blood in the stool, black and tarry stool, ascites (abnormal fluid collection within the peritoneum, the sac that contains the intestines within the abdominal cavity), confusion and lethargy, splenomegaly or enlargement of the spleen, and decreased white blood cell counts.
Primary Biliary Cirrhosis (PBC) TreatmentPrimary biliary cirrhosis (PBC) is thought to be an autoimmune disorder that involves the deterioration of the liver's small bile ducts. These ducts are crucial to transport bile to the small intestine, digesting fats and removing wastes. Symptoms of PBC are edema, itching, elevated cholesterol, malabsorption of fat, liver cancer, gallstones, urinary tract infections (UTIs), and hypothyroidism. Treatments include ursodeoxycholic acid (UDCA); colchicine (Colcrys); and immunosuppressive medications, such as corticosteroids; obeticholic acid (Ocaliva); and medications that treat PBC symptoms. For PBC that is associated with cirrhosis of the liver, liver transplantation may be indicated in extreme cases.