A 50-year-old man with alcoholic cirrhosis has recurrent tense ascites requiring frequent large-volume paracentesis (every 1-2 weeks) despite maximal diuretic therapy. Child-Pugh score is 9 (class B), MELD is 14. Which is the most appropriate next step?
- A Liver transplantation evaluation
- B Peritoneovenous shunt
- C Transjugular intrahepatic portosystemic shunt (TIPS) ✓
- D Continue repeated paracentesis indefinitely
Correct answer: C. Transjugular intrahepatic portosystemic shunt (TIPS)
Explanation
TIPS is indicated for refractory ascites requiring frequent paracentesis (more than 3 times per month) despite adequate diuretic therapy. It reduces portal pressure and improves sodium excretion. Peritoneovenous shunts are rarely used due to complications. While transplant evaluation is important, TIPS serves as a bridge or alternative for patients who are not immediate transplant candidates.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.