title: Hepatic encephalopathy following transjugular intrahepatic portosystemic shunt (TIPS): management with L-ornithine-L-aspartate and stent reduction.
abstract: Hepatic encephalopathy (HE) is a common problem after insertion of a trans-jugular intrahepatic portosystemic shunt (TIPS), which may be difficult to manage. We present a case of severe post-TIPS HE unresponsive to high doses of L-ornithine-L-aspartate (LOLA) despite reduction of venous ammonia levels in a dose-dependent fashion. Ultimately, high-grade HE was successfully treated by a reduction stent and the patient subsequently underwent successful liver transplantation.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria. v.stadlbauer@ucl.ac.uk
authors.forename: Vanessa
authors.initials: V
authors.lastname: Stadlbauer
authors.forename: Josef
authors.initials: J
authors.lastname: Tauss
authors.forename: Horst R
authors.initials: HR
authors.lastname: Portugaller
authors.forename: Philipp
authors.initials: P
authors.lastname: Stiegler
authors.forename: Florian
authors.initials: F
authors.lastname: Iberer
authors.forename: Rudolf E
authors.initials: RE
authors.lastname: Stauber
mesh_terms: D000368:Aged; D000641:Ammonia / Q000097:blood; D004151:Dipeptides / Q000008:administration & dosage*; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications; D015607:Stents
chemical_list: D004151:Dipeptides; D000641:Ammonia; C002939:ornithylaspartate