BackTable / VI / Podcast / Episode #127
Portal Hypertension and Ascites Management
with Dr. Parvez Mantry
Interventional Radiologist Christopher Beck talks with Hepatologist Parvez Mantry about the management of Portal Hypertension and Ascites, and the importance of multi-disciplinary collaborative care for these patients.
BackTable, LLC (Producer). (2021, May 17). Ep. 127 – Portal Hypertension and Ascites Management [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Parvez Mantry
Dr. Parvez Mantry is the Medical Director of the Liver Institute Research and the Hepatobiliary Tumor Program at the Methodist Health System in Dallas, Texas.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
In this episode, hepatologist Dr. Parvez Mantry joins our host Dr. Christopher Beck to discuss portal hypertension and ascites, two complications that arise from liver diseases and have a large effect on patients’ quality of life.
Dr. Mantry starts the episode by sharing statistics on Chronic Liver Disease (CLD) and specifically highlights the burden of CLD on the U.S. population. He discusses various causes of CLD, including Hepatitis C, Alcohol Liver Disease, and Non-Alcoholic Steatohepatitis.
Next, Dr. Mantry takes us through his diagnostic workup, including his physical examination, cross-sectional imaging, percutaneous and transjugular liver biopsies, and serological workup. He checks for complications such as portal hypertension, ascites, pedal edema, and hepatic encephalopathy. We also discuss the diagnosis of Hepatocellular Carcinoma (HCC).
Then, we transition to strategies for managing ascites and portal hypertension through diuretics, paracentesis, Transjugular Intrahepatic Portosystemic Shunts (TIPS), liver
transplantation, and a few experimental treatments that he is currently researching. Overall, Dr. Mantry advocates for close monitoring of symptoms and making treatment modifications as needed.
Finally, when focusing on the patient experience, Dr. Mantry offers troubleshooting tips, especially for patients who struggle with leakage from the paracentesis site. To close, he gives insights on how physicians can best support chronically-ill patients who are awaiting transplantation.
Methodist Transplant Specialists- https://www.theliverinstitutetx.com/
Information about Dr. Mantry’s transplant center and its satellite locations in the Dallas-Ft. Worth Community.
American Association for the Study of Liver Diseases (AASLD) Practice Guidelines- https://www.aasld.org/publications/practice-guidelines
Management of HCC- https://www.journal-of-hepatology.eu/article/S0168-8278(12)60009-9/pdf
The Management of Ascites in Cirrhosis- https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1053/jhep.2003.50315
These are guidelines set by the International Ascites Club.
BackTable Pdcast Ep. 123 TIPS University Freshman Year: Referrals and Pre-Op Workup- https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup
[Dr. Parvez Mantry]
When patients have mild or moderate ascites (which means that I can feel the ascites, but their belly is not tense) and they have a lot of pedal edema, I will usually start them with a combination of furosemide and spironolactone. With a loop diuretic, potassium-sparing diuretic, and salt restriction, we may be able to manage the ascites 70% to 80% of the time. In the other scenario where somebody comes with tense ascites, their abdominal wall is stretched, their umbilicus is everted, and they are usually very uncomfortable. In addition to starting them on diuretics, I will usually perform a paracentesis in the office and remove 8-10 liters of fluid and give intravenous albumin. Now, patients who require paracentesis on a weekly basis, with livers that are still salvageable (measured by MELD score), are suitable candidates for placement of a transjugular intrahepatic portosystemic shunt (TIPS). And then we have some experimental therapies that are coming up for management of ascites as well.
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