TIPS经颈内静脉肝内门腔分流术

（优选）TIPS经颈内静脉肝内门腔分流术目前一页\总数五十一页\编于十七点

Howisitperformed?ThepatientlaysonhisbackonanX-raytable.Theinternaljugularveinintheneckislocated.Theskiniscleansed,andathinneedleisusedtoinjectalocalanesthetictothepuncturearea.ASeldingerneedleisusedtopassacatheter(overawire)thatismoveddowntotheliver.Aspecialbiopsyneedleisthenusedthroughtheguidingsheathtoobtainthebiopsysample.目前二页\总数五十一页\编于十七点WhyTransjugular?Themainadvantageofthetransjugularapproachtoliverbiopsyisthatthelivertissueisobtainedwithinthevascularsystem,therebyminimizingtheriskofbleeding.Remember:Liverdeseaseleadstocoagulationproblems.Thetransjugularapproachismostcommonlyusedforpatientsinwhomapercutaneousapproachisconsideredtobeunsafe.-Coagulopathy-Ascites

目前三页\总数五十一页\编于十七点

Firstly,letusknowmuchbasicknowledge!thenyouwouldbeeasyunderstandnextslide.目前四页\总数五十一页\编于十七点目前五页\总数五十一页\编于十七点

Anatomy目前六页\总数五十一页\编于十七点目前七页\总数五十一页\编于十七点

PortalVeinSystem目前八页\总数五十一页\编于十七点目前九页\总数五十一页\编于十七点

AbdominalVenousSystemVenaCava-RenalVeins-IliacVeins-HepaticVein**VenaPorta

-EsophagalVeins-Left&RightGastricVeins-SplenicVein-SuperiorMesentericVein-InferiorMesentericVein目前十页\总数五十一页\编于十七点

TheliverandHowitworksItdoeshundredsofvitalthingstomakesureeverythingrunssmoothly:-Storesvitamins,sugarandirontohelpgiveyourbodyenergy.-Controlstheproductionandremovalofcholesterol.-Clearsthebodyofwasteproducts,drugsandotherpoisonoussubstances.目前十一页\总数五十一页\编于十七点

TheliverandHowitworks-Makesclottingfactorstostopexcessivebleeding.-Producesimmunefactorsandremovesbacteriafromthebloodstreamtocombatinfection.-Releasesasubstancecalled“bile”tohelpdigestfoodandtoabsorbimportantnutrients.目前十二页\总数五十一页\编于十七点WhatisCirrhosisandPortalHypertension?目前十三页\总数五十一页\编于十七点

CirrhosisoftheLiver目前十四页\总数五十一页\编于十七点

CirrhosisoftheLiverWithcirrhosis,thenormallivercellsaredamagedandreplacedbyscartissue.Thisdistortionofthenormalliverstructureinterfereswiththeflowofbloodthroughtheliver.Thebodyrespondsbydivertingthisbloodthroughbloodvesselssurroundingtheupperportionofthestomachandthelowerportionoftheesophagus.目前十五页\总数五十一页\编于十七点

CirrhosisoftheLiverTheincreasedbloodvolumeintheseveinscausesformationofVarices.Varicesareswollenveinswithaweakenedwall.TheseVaricesoftenruptureunderincreasedpressure,causingmassivebleeding.目前十六页\总数五十一页\编于十七点

PortalHypertension

Portalhypertensionisanincreasedpressureintheliver’scirculatorysystem,duetoalargebloodpressuredifferencebetweentheportalveinandtheinferiorvenacava.Portalhypertensionismostcommonlycausedbycirrhosis.目前十七页\总数五十一页\编于十七点目前十八页\总数五十一页\编于十七点Couldyoutellmeboth2relation?

CirrhosisPortalHypertensionYESorNO目前十九页\总数五十一页\编于十七点

Howtodealwith?目前二十页\总数五十一页\编于十七点目前二十一页\总数五十一页\编于十七点目前二十二页\总数五十一页\编于十七点目前二十三页\总数五十一页\编于十七点目前二十四页\总数五十一页\编于十七点目前二十五页\总数五十一页\编于十七点目前二十六页\总数五十一页\编于十七点目前二十七页\总数五十一页\编于十七点目前二十八页\总数五十一页\编于十七点目前二十九页\总数五十一页\编于十七点目前三十页\总数五十一页\编于十七点目前三十一页\总数五十一页\编于十七点目前三十二页\总数五十一页\编于十七点WhatdoesCookofferfor

PortalHypertension

目前三十三页\总数五十一页\编于十七点目前三十四页\总数五十一页\编于十七点目前三十五页\总数五十一页\编于十七点目前三十六页\总数五十一页\编于十七点目前三十七页\总数五十一页\编于十七点

HowtodotheTIPS?

目前三十八页\总数五十一页\编于十七点目前三十九页\总数五十一页\编于十七点

HowtoTIPS目前四十页\总数五十一页\编于十七点目前四十一页\总数五十一页\编于十七点TIPSprocedure

AcatheterisplacedintherightjugularVein.Thecatheteristhreadedthroughthesuperiorandinferiorvenacavatothehepaticvein.Thewallofthehepaticveinispuncturedandtheneedleisdirectedtotheportalvein.-Successfulpassageintotheportalveinisdeterminedbyinjectingdyethroughthecatheter.目前四十二页\总数五十一页\编于十七点TIPSprocedure

Aguidewireisthreadedthroughtheneedletomaintainthepassagebetweenthehepaticandportalveins.目前四十三页\总数五十一页\编于十七点TIPSprocedureAballoonisusedacrossthepassagetowidentheholesinthevesselwallsandthepassagethroughthelivertissue.目前四十四页\总数五十一页\编于十七点TIPSprocedure-Astentisthenpositionedalongthepassage,overlappingthelivertissueandextendingintobothveins.Thestentisopenedtoitsmaximumwidthwithballoondilation.Bloodflowfromtheportalveinacrossthestenttothehepaticveinandintothevenacavaisconfirmedby