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Chapter 10 ♦ Liver, Gallbladder, and Biliary Tree Disorders

A

B

Hepatic vein

Portal vein

C

D

E

Hepatic vein

Portal vein

d. Sengstaken–Blakemore tube: Nasogastric tube with esophageal and gastric balloons for tamponade of varices used in the acute setting. e. TIPS: Can be done emergently for refractory bleeding (Fig 10-5). B. Surgical: 1. Acute massive bleeding requires intervention. 2. Surgical shunts (portacaval, mesocaval, distal splenorenal) are rarely done due to high mortality. VI. Prognosis. Fair to poor; patients who bleed once are at high risk of rebleeding. Figure 10-5: Transjugular intrahepatic portosystemic shunt. A wire is passed through a hepatic vein branch (A), across the liver parenchyma (B), and into a portal vein branch (C). The parenchymal path is dilated (D) and a stent is placed across it to maintain patency of the newly created venous conduit (E). This conduit allows the portal blood to flow freely into the systemic venous system, thus lowering portal pressure and the propensity to bleed from esophageal varices. (From Mulholland MW, Lillemoe KD, Doherty GM, et al. Greenfield’s Surgery , 4th ed. Baltimore: Lippincott Williams & Wilkins; 2005.)