Internal Medicine

Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Portal Hypertension

Portal hypertension is the increased blood pressure within the portal venous system, which can lead to serious complications like variceal bleeding, refractory ascites, and hepatic hydrothorax. TIPS reduces portal hypertension by diverting a portion of the portal blood flow directly into the systemic circulation, thereby decreasing the pressure in the portal venous system

The key indications include recurrent variceal bleeding that is unresponsive to endoscopic or pharmacological treatments, refractory ascites that does not respond to diuretics or repeated paracentesis, and hepatic hydrothorax resistant to medical therapy. Additionally, TIPS may be used in managing Budd-Chiari syndrome, where thrombosis of the hepatic veins leads to increased portal pressure.

Transducer marker pointing towards the patient’s right shoulder

Note the overall activity of the heart and any gross abnormality

Note any pericardial effusion especially below the posterior wall

Examine the cardiac segments motion and structure

What do you see here?

How to differentiate the vein from the artery:

The vein is usually:

• Oval in shape, thin walled

• Compressible with gentle pressure

• Non pulsatile

Color Flow (CF)

When applying Color Flow, the top of the box on the left of the screen will indicate the color of the flow towards the transducer, and the bottom of the box indicates the color of the flow away from the transducer. In this example the Flow towards the transducer is red, and the flow away from the transducer is blue

M-mode through the diaphragm showing its movements with deep inspiration as we discussed in our POCUS workshop

@Everyone