Cirrhosis

What is Cirrhosis?

Cirrhosis is a chronic disease of the liver, typically due to repeated inflammation, resulting in scarring of healthy liver tissue. The scarring of the liver increases the pressure in the portal vein (the venous system that drains the spleen and intestines and supplies 80% of the blood to the liver) and causes the vast majority of the symptoms and side effects of cirrhosis. Researchers estimate that about 1 in 400 adults in the United States has cirrhosis and they believe the actual numbers are possibly much higher because many go undiagnosed.

Symptoms

• Easily bleeding or bruising
• Loss of appetite
• Nausea
• Swelling in your legs, feet or ankles (edema)
• Itchy skin
• Yellow discoloration in the skin and eyes (jaundice)
• Gastrointestinal bleeding
• Abdominal swelling
• Confusion.

How is Cirrhosis treated?

Cirrhosis is typically treated using a combination of medications and interventions.

• Medical management – a combination of diuretics, ammonia-reducing medications, and a regulated diet
• Intervention:
  • For ascites:
    • Paracentesis – needle drainage of abdominal fluid
    • TIPS – for recurrent ascites – decreases portal venous pressure allowing ascites to reabsorb
  • For bleeding varices:
    • Variceal banding via EGD
    • TIPS – decreasing portal venous pressure also decompresses the esophageal varices

What is TIPS Placement?

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Placement procedure is when a stent is placed in an intrahepatic (within the liver) tract created between the portal and systemic venous systems. This is used to decrease the increased portal venous pressure in patients with cirrhosis or other syndromes causing portal hypertension. It is most commonly done for recurrent ascites (fluid in the belly) and esophageal bleeding.

Utilizing ultrasound guidance your right internal jugular vein is accessed with a needle, and a wire is passed through the needle into the vein. Using X-ray guidance, the wire is guided into a hepatic vein and once there, a longer needle is then used to puncture from the hepatic vein into a branch of the portal vein. This needle is hollow and a wire is then advanced through the needle into the portal vein.

Over this wire, a stent is placed in this new tract allowing for a direct pathway between the portal and systemic venous systems.

The TIPS Placement procedure is performed in a hospital with general anesthesia.