TIPS University Freshman Year: Referrals and Pre-op Workup

In this episode, Dr. Emmett Lynskey joins Dr. Chris Beck for the first edition of TIPS University to discuss referrals and pre-op for transjugular intrahepatic portosystemic shunts (TIPS). Dr. Lynskey begins by telling us about his fellowship at Georgetown, his current practice, and how he became interested in portal hypertension.

We talk through the most common indicators for a TIPS procedure, including refractory ascites, portal vein thrombosis, and acute bleeders. Dr. Lynskey explains how patients are referred to him, and he outlines what factors he considers before determining the eligibility for TIPS. We then discuss how useful cross sectional imaging is, and we break down the Model for End-Stage Liver Disease (MELD) score. Dr. Lynskey shares the components that make up the MELD score as well as the cutoffs and thresholds for a TIPS patient.

Next, we review diuretics and emphasize the importance of being honest with patients regarding expectations post-procedure. We explain how to phrase questions when working with cardiologists. Dr. Lynskey goes over what all he can determine from cross-sectional imaging prior to the procedure, and he tells us when he might consider an alternative to TIPS.

We discuss which labs should be done the day of the procedure and why Dr. Lynskey gets MELD labs again just before the TIPS. Dr. Lynskey tells us about blood typing, crossmatching, and fibrinogen levels. The episode wraps with Dr. Lynskey explaining the benefits of performing a paracentesis prior to TIPS.