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Title: Transjugular intrahepatic portosystemic stent-shunt
Author: Jalan, Rajiv
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2000
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The purpose of this thesis was to evaluate (i) the effect of TIPSS on the natural history of cirrhosis (ii) the changes in shunt function following its insertion and study the potential pathogenic mechanisms (iii) the place of TIPSS in the management of variceal haemorrhage in patients with cirrhosis and (iv) the use of TIPSS as a 'model' to study the pathogenesis of sodium retention in patients with cirrhosis. The thesis aims to answer these questions by studying defined cohorts of patients with cirrhosis and portal hypertension undergoing TIPSS insertion for a variety of indications. The thesis is divided into various sections which deal with the above questions. The first section deals with the outcome of patients with cirrhosis treated with TIPSS and assesses the factors predicting mortality, rebleeding, encephalopathy and shunt insufficiency. It also prospectively assesses changes in liver function, neuropsychological profile, haematological profile and appraises their relationship with changes in the portal pressure. Studies in the next section were designed to evaluate the methods for assessment of shunt function and to study the pathogenesis of shunt insufficiency. The place of TIPSS in the management of variceal haemorrhage in patients with cirrhosis is evaluated in a randomised and controlled study in comparison with variceal band ligation. The last section looks at the mechanisms of sodium retention in cirrhosis particularly with reference to the 'hepatorenal reflex'. The final chapter is dedicated to discussing the findings of this study in the light of the available literature and define the areas of deficiency in our understanding and to outline future perspectives. In conclusion, TIPSS is an exciting innovation which is relatively safe and can be performed in the vast majority of patients with cirrhosis with a very low procedure related mortality. Although its place in the management of uncontrolled variceal haemorrhage appears certain, further controlled studies are needed to assess its role in the secondary prophylaxis of variceal haemorrhage and in refractory ascites.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available