A 54 year old male has diuretic-refractory ascites, ie. he can’t tolerate maximum doses of furosemide and spironolactone; he developed severe hyponatremia (Na 121). He asks you if TIPS is a good idea for his tense ascites. All of the following are important considerations except one.
A. check an ultrasound with doppler to be sure there is no portal vein thrombosis (PVT)
B. get a cardiac echo to be sure there is no pulmonary hypertension
C. check a renal ultrasound to be sure the problem isn’t in his kidneys
D. inquire about the patient’s history of hepatic encephalopathy
Answer:D
A 54 year old male has diuretic-refractory ascites, ie. he can’t tolerate maximum doses of furosemide and spironolactone; he developed severe hyponatremia (Na 121). He asks you if TIPS is a good idea for his tense ascites. All of the following are important considerations except one.
A. check an ultrasound with doppler to be sure there is no portal vein thrombosis (PVT) B. get a cardiac echo to be sure there is no pulmonary hypertension C. check a renal ultrasound to be sure the problem isn’t in his kidneys D. inquire about the patient’s history of hepatic encephalopathy