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Management of post‐TIPS refractory Hepatic Encephalopathy (HE)
🟢 Definition
🟡 Prevention
🔵 Medical Rx
🔴 Endovascular approach
1/
Management of post‐TIPS refractory Hepatic Encephalopathy (HE)
🟢 Definition
🟡 Prevention
🔵 Medical Rx
🔴 Endovascular approach
1/
🟢 HE maybe:
Covert: Minimal or West haven Gr 1
Overt: West Haven Gr 2-4 which maybe episodic, recurrent (bouts within 6 mo) or persistent ( behavioral changes present with intermittent overt HE)
2/
Covert: Minimal or West haven Gr 1
Overt: West Haven Gr 2-4 which maybe episodic, recurrent (bouts within 6 mo) or persistent ( behavioral changes present with intermittent overt HE)
2/
Why does post-TIPS HE occur?
1.Shunting of blood away from liver- decreases 1st pass clearance of intestinal toxins (ammonia)
2. Upregulation of intestinal glutaminase activity- Increase ammonia production
1yr incidence 10-50%
New/ worsening 13-36%
Severe 1-3%
3/
1.Shunting of blood away from liver- decreases 1st pass clearance of intestinal toxins (ammonia)
2. Upregulation of intestinal glutaminase activity- Increase ammonia production
1yr incidence 10-50%
New/ worsening 13-36%
Severe 1-3%
3/
