Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
20 Cards in this Set
- Front
- Back
|
what is TIPS |
transjugular hepatic portoststemic shunt (metal) placed in veins in the middle of the liver to permit blood flow to bypass the liver |
|
|
where does blood flow in and out of the liver |
in through the portal vein, leaves via the hepatic vein which empties into the IVC leading to the heart |
|
|
what is portal hypertension |
increased pressure in the liver's circulatory system which occurs when there is a large pressure difference between the portal vein and the IVC |
|
|
what causes portal hypertension |
cirrhosis or portal vein obstruction |
|
|
how does cirrhosis cause portal hypertension |
liver cells are damaged and replaced with scar tissue this distortion interferes with blood flow through the liver body diverts the flood of blood through vessels surrounding the upper stomach and the lower esophagus increased blood flow in these veins cause varices |
|
|
what are varices |
swollen veins with weakened walls which often rupture under pressure |
|
|
how can esophageal varices be controlled |
compression of bleeding vessels using balloon-tamponade tube which applies direct pressure to varices drugs to decrease portal vein pressure sclerotherapy placement of TIPS |
|
|
describe TIPS procedure |
rad makes tunnel through the liver to connect the portal vein to one of the hepatic veins and TIPS placed to keep tunnel open |
|
|
what does portal hypertension/increased pressure in the portal vein cause |
backward flow from the liver to the spleen, stomach, lower esophagus, and intestines causing enlarged vessels, bleeding, and accumulation of fluid in the chest and abdomen |
|
|
what are indications for TIPS |
corrects complications of portal hypertension: bleeding from veins that normally drain the stomach, esophagus, and intestines into the liver portalgastrophy and engorgement of veins in the walls of the stomach causing severe bleeding severe ascites (fluid in abdo) or hydrothorax (fluid in chest) budd chian syndrome which is blockage in one or more veins that carry blood form the liver back to the heart |
|
|
who are the best candidates for TIPS |
patients who have failed traditional endoscoptic management of variceal bleeding or patients with failing treatment for ascites optimally are eligible for transplant, portal vein patency |
|
|
can TIPS be successful in patients who have partially or fully blocked portal veins |
yes |
|
|
how invasive is a TIPS procedure |
minimally invaseive |
|
|
what kind of anesthesia is used for TIPS |
some use general anesthesia, others use conscious sedation |
|
|
how is the patient positioned |
supine |
|
|
describe TIPS insertion procedure |
US is used to locate jugular vein, area injected with local anesthetic incision is made, guidewire is inserted followed by catheter catheter threaded through SVC to hepatic vein wall of hepatic vein punctured and needle is directed across a 2" gap to the portal vein successful passage into portal vein determined by pattern of dye injected through the catheter pressure measured in hepatic vein and right side of heart to confirm portal hypertension and determine it's severity contrast injected to outline portal venous system TIPS needle used to gain access to hepatic vein into the portal system stent pstned and balloon inflated expanding stent into place balloon is then deflated and removed along with the catheter leaving the stent in place |
|
|
how is good placement confirmed |
pressures are measured to confirm reduction in portal hypertension, portal venograms performed to confirm blood flow through TIPS |
|
|
How long does a TIPS procedure take |
can be completed in an hour, may take longer depending on patient. Typically the patient is admitted to the hospital following the procedure for close observation |
|
|
what is post procedural pt care for TIPS procedure |
pt may be admitted to hospital pts blood pressure and pulse checked frequently and are monitored for any bleeding pt kept in fowlers pstn for a few hrs catheter remains in right jugular and IV runs through catheter, line remains for a day+ abdo US done the day after to check for effectiveness |
|
|
what are danger signals to looks for |
swellling of abdo and legs sudden weight gain restlessness shortness of breath ensephalopathy (confusion or memory loss) increased sleepiness or fatigue |
