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Liver & Portal Veins

Conditions related to the liver, bile ducts and portal veins.

Liver & Portal Veins

Hepatobiliary procedures involve the liver, portal veins, gallbladder and bile system. This category includes many procedures, however only a select few are listed here. Biopsies are discussed in the biopsy section. Procedures involving malignancy and other masses are discussed in the oncology section. 

TIPS & related procedures – TIPS stands for Transvenous Intrahepatic Portosystemic Shunt. It is commonly performed in cases of cirrhosis. In cirrhosis, the liver becomes stiff, causing increased pressure within the veins draining into the liver. This increased pressure can cause the draining veins to become enlarged and abnormal, possibly leading to life-threatening bleeding. The increased pressure can also cause fluid to leak outside of the veins, leading to ascites. TIPS is therefore often used for the treatment of varices (abnormal veins) or recurrent ascites (fluid in the abdomen) caused by cirrhosis. TIPS uses a stent to partially bypass the hardened liver, improving the increased pressure. 

TIPS is not for everyone with cirrhosis. A thorough workup is needed to make sure the procedure is safe and indicated. During this workup, the procedure will be discussed in detail. If indicated, TIPS can significantly reduce the risk of bleeding from varices, reduce or eliminate the need for paracentesis and in some cases improve kidney function.

Cholecystostomy tube – In some patients with cholecystitis, removing the gallbladder (cholecystectomy) is not possible. In order to drain the blocked gallbladder, a tube is placed to allow bile to flow outside the body.

Percutaneous biliary drainage and stenting – When bile is unable to flow from the liver, it can cause damage to the liver, be a source of infection, and cause symptoms such as jaundice and itching. This is most commonly from a mass or tumor, although can happen for a variety of reasons. A tube is placed by the interventional radiologist to drain bile outside the body or across the blockage into the small bowel, where bile usually flows. In some cases, a stent can be placed across the blockage to allow normal flow of bile without the need for a drain.

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