GASTROENTEROLOGY ARTICLE OF THE WEEK
January 26, 2012
Bhogal HK, Sanyal AJ. Using Transjugular intrahepatic portosystemic shunts for complications of cirrhosis. Clin Gastroenterol Hepatol 2011:9;936-46.
1. A 58 year old cirrhotic who underwent TIPS placement 2 years ago for variceal bleeding is found to have Grade 2 esophageal and gastric varices without bleeding or stigmata. An US shows flow in the TIPS. Next step in this patient should be
a. observation
b. variceal banding
c. selective beta blockers
d. angiography to evaluate the TIPS
e. oral nitrates
True or False
2. Overall risk of shunt stenosis at 1 year using covered stents is 24%, with bare stents is 76% at 2 years
3. Patients with acute variceal bleeding and portal pressure of >20mmHg are more likely to fail endoscopic and pharmacologic therapy
4. TIPS is an effective pre-transplant temporizing measure for patients with hepato-pulmonary syndrome
5. Target hemoglobin in patients suffering from variceal bleeding should be 10-11 grams
6. Patients with variceal bleeding who have multiorgan failure of high MELD scores are not helped by TIPS
7. Patients presenting with variceal bleeding and a CP score >13 should have early TIPS
8. TIPS for refractory ascites clearly prolongs life.
9. Hepatic encephalopathy secondary to TIPS placement usually becomes clinically apparent 24 to 48 hours after TIPS placement
10. TIPS is usually effective for patients with ectopic variceal bleeding, particularly intestinal stoma varices.
11. TIPS-associated hemolysis is less common with covered stents