MC cause of gastric varices?
MC cause of isolated gastric varices?
Splenic vein thrombosisQ
Sarin classification of Gastric Varices?
- :1. Gastroesophageal varices
- 2. Isolated gastric varices.
- ₋₋Type 1: Varices located in the fundus of the stomachQ
- ₋₋Type 2: Isolated ectopic varices located anywhere in the stomachQ
Cause of isolated gastric varices?
Secondary to splenic vein thrombosisQ
Treatment of gastric varices?
- Gastric varices in splenic vein thrombosis: SplenectomyQ.
- Gastric varices in portal hypertension - managed like esophageal varicesQ.
Vessels involved in gastric varices?
- In portal HTN - transmitted by the left gastric veinQ to esophageal varices and by the short and posterior gastric veinsQ to the fundic plexus and cardia veins.
- Splenic blood flows retrograde through the short and posterior gastric veins into the varices, then hepatopetally through the coronary veinQ into the portal vein.
Technique of Placement of TIPPS?
- Right internal jugular vein -shortest and most direct path to catheterize the hepatic veinsQ.
- Right hepatic vein is MC used - largest hepatic vein and has the most favourable orientationQ.
- Portal vein is cannulated by Rosch needle.
- Portal vein is localized by carbon dioxide wedge hepatic venographyQ.
- Portal venogram before dilating parenchymal tract is crucial, provides confirmation that portal vein has been accessed
Features of Stent in TIPPS?
- • The VIATORR is a stent-graftQ specifically designed for TIPSS
- .• 2 cm long bare stent segment - consists of three PTFE layersQ, one of which is an impermeable film to prevent bile leak into the shunt.
Indications of TIPSS?
- 1. Prevention of rebleeding from varices (MC)Q
- 2. Acute variceal BleedingQ
- 3. Refractory ascitesQ
- 4. Hepatorenal syndromeQ
- 5. Refractory hepatic hydrothoraxQ
- 6. Budd-Chiari syndromeQ
- 7. Hepatic veno-occlusive diseaseQ
- 8. Portal hypertensive gastropathyQ
Cause of stenosis in TIPPS?
Neointimal hyperplasia and is more common than thrombosisQ
Types of non-selective shunt?
- 1. Eck fistulaQ
- 2. Side-to-side PCS (SSPCS)Q
- 3. Interposition graft (portacaval, mesocaval, mesorenal)Q
- 4. Proximal splenorenal shuntQ
Types of selective shunt?
- 1. Distal splenorenal shunt (Warren shuntQ)
- 2. Inokuchi shuntQ
What is partial shunt?
Diameter of shunt <10 mmQ