TIPS Contraindications — RACP Adult Medicine MCQ
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Correct answer: B — Recurrent hepatic encephalopathy
TIPS is contraindicated in patients with recurrent or refractory hepatic encephalopathy, as it creates a portosystemic shunt that diverts ammonia-laden portal blood directly into the systemic circulation, dramatically worsening encephalopathy. Other contraindications include right heart failure (TIPS increases venous return), severe pulmonary hypertension, portal vein thrombosis (relative), and uncontrolled systemic infection. High MELD scores (>18–20) predict worse post-TIPS outcomes and should be carefully weighed.
Reference: eTG – 2025 – Gastrointestinal; EASL – 2018 – Decompensated Cirrhosis; AASLD – 2019 – TIPS Position Paper