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TIPS for Refractory Ascites — RACP Adult Medicine MCQ

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ModerateGastroenterologyTIPS for Refractory AscitesRACP Adult Medicine

A 60-year-old man with hepatitis C cirrhosis develops progressive abdominal distension and bilateral leg oedema despite maximum diuretics (spironolactone 400 mg + furosemide 160 mg daily). He requires large-volume paracentesis every 2 weeks. Sodium restriction is strict. What is the most appropriate next step for refractory ascites?

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Correct answer: B — TIPS (transjugular intrahepatic portosystemic shunt)

Refractory ascites (diuretic-resistant or diuretic-intractable) after maximum diuretics and sodium restriction = consider TIPS. TIPS reduces portal pressure by creating an intrahepatic shunt. It is more effective than repeated large-volume paracentesis for refractory ascites but has complications (hepatic encephalopathy in 30-50%, TIPS dysfunction). Contraindications: Child-Pugh >13, MELD >18 (relative), active HE, heart failure. Liver transplant assessment should occur simultaneously.

Reference: GESA – 2024 – Refractory Ascites; EASL 2024