Q) A 60-year-old man with cirrhosis presents with refractory ascites requiring frequent large-volume paracentesis. He is evaluated for TIPS placement. Which of the following findings would be the strongest contraindication to proceeding with the procedure?
A) Serum bilirubin of 3.5 mg/dL B) MELD score of 18 C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg D) History of prior hepatic encephalopathy controlled on lactulose
#Theme from INI CET GI Mock test Liver
Correct Answer:
C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg
Explanation:
A mean pulmonary artery pressure >45 mmHg is a contraindication to TIPS due to the risk of worsening right heart failure.
Bilirubin up to 3.5 and a MELD score <25 are relative risks but not absolute contraindications.
Prior controlled hepatic encephalopathy is not a strict contraindication, though the risk of recurrence post-TIPS is higher.
TIPS is often used in patients with refractory ascites when medical management fails.
