ANOTHER SUCCESS STORY OF ELDERLY FEMALE WITH MULTIPLE COMORBITIES

Diagnosis DECOMPENSATED CHRONIC LIVER DISEASE

1. WITH REFRACTORY ASCITES(NASH Related),HIE Grade 1-2

2. ACUTE KIDNEY INJURY(HRS),

3. BROCNHIAL ASTHMA

4. HYPOTHYROID

5. DIABETES MELLITUS, HTN,

6. SICK SINUS SYNDROME

7. CHRONIC ANAEMIA ,

8. UTI

Hospital Course - 75/ Female patient had been diagnosed as a case of Chronic Liver Disease - NASH related and developed Abdominal distention requiring regular admissions with large volume paracentesis multiple times over last months. She had developed Acute kidney injury during the current admission with tense ascites and required large volume paracentesis 2 times in the same admission. Every time of tapping would yield about 7 litres of fluid which was draining the patient physically and her overall prognosis was worsening. She was in need of an urgent liver transplant. But due to her age, multiple comorbidities and frail condition, she was deemed unfit for transplant.Hence a multidisciplinary team meet was arranged and after careful evaluation she was deemed fit for TIPPS procedure.

On day 9 after admission into hospital, patient underwent TIPPS procedure by Dr Sridhar Reddy and team

( Interventional Radiology). Post procedure patient was observed for few days in ICU, she had shown rapid improvement in her symptoms. She was shifted out and her abdominal distention reduced, her acute kidney injury improved and she was clinically much better. After 15 days of hospital stay she was disharged today with a smile on her face with much better physical condition. She has been asked to come on follow up and expecting her to stay safe and better

Again it's Team Effort by Medical Gastroentrtology Dr Sameer & Team,Critical Care Dr Raghu Kondle & Team, Interventional Radiology Dr Sridhar Reddy & Team,Anaesthesiology Dr K Shreevani & Team,supported by Cardiologist, Nephrologist, Cath Lab Unit during TIPSS Procedure, Ward Doctors & Staff and all others who are involved. I Thanq Medical Director sir & Management Team for Supporting and Encouraging .

Why this case needs discussion - Not all patients of end stage liver disease are candidates for liver transplant. If carefully selected patients can be given TIPSS as alternate therapy for patients with Refractory ascites. If done at appropriate time, with proper indication and with adequate expertise, TIPSS can give excellent results .Many Centers hardly perform TIPSS, First of its kind is done at Vasavi Hospital and Research Center