A transjugular intrahepatic portosystemic shunt (TIPS) procedure is a treatment method used to lower portal hypertension, or excessive pressure in your portal vein. This vein is responsible for carrying blood from your abdomen to your liver. Excess pressure can lead to significant bleeding and fluid buildup in your abdomen, which is known as ascites. After undergoing a TIPS procedure, adhering to a specific diet is crucial for managing potential complications and promoting overall well-being. This article provides a detailed guide to the dietary recommendations following a TIPS procedure, drawing upon available research and expert advice.
Understanding the TIPS Procedure
A TIPS procedure involves creating a shunt between your portal vein and your hepatic vein by placing a stent. Here are each of the three parts of the procedure:
- Shunt: Something that re-routes or re-directs flow from its normal pathway.
- Portal vein: The vein that transports blood from your gastrointestinal system, gallbladder, pancreas, and spleen on the way to your liver.
- Hepatic vein: The veins (usually three) that return blood that doesn’t have oxygen from your liver back to your heart.
A specialist known as an interventional radiologist will perform the procedure, typically in a specialized operating suite known as an interventional radiology suite. During this time, an interventional radiologist will use X-ray guidance to place the shunt. Those who need a TIPS procedure are usually moderately to severely ill.
Examples of conditions and acute occurrences that may warrant a TIPS procedure include:
- Budd-Chiari syndrome: A rare disorder that affects the ability of blood to leave the liver, which causes significant portal hypertension.
- Hepatopulmonary syndrome: A syndrome that occurs in people with significant liver disease that affects the abilities of their lungs to work well.
- Hepatorenal syndrome: A condition where a person experiences significant liver failure that also affects the way their kidneys work.
- Portal hypertensive gastropathy: Bleeding in the stomach and stomach lining due to portal hypertension.
- Refractory ascites: Ascites (severe swelling in the abdomen) that won’t respond to traditional treatments.
- Refractory hepatic hydrothorax: Severe pleural effusion (fluid buildup outside the lungs) that’s a result of significant liver disease.
- Variceal hemorrhage: A condition that causes veins in the esophagus or stomach to bleed profusely.
Doctors will usually perform a TIPS procedure after other first-line treatments have failed. For example, doctors may try to lower ascites by draining the excess fluid or variceal fluid by banding or stopping bleeding in your esophagus. If these fail, a doctor may recommend a TIPS procedure.
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Why is Diet Important After TIPS?
The liver is an important receiver and transporter of blood in your body. When your liver doesn’t work well, its poor function can impact multiple organ systems and cause symptoms that can become indicators for the TIPS procedure. After a TIPS procedure, the liver's function may be altered, and complications like hepatic encephalopathy can arise. Hepatic encephalopathy is a common complication in patients who have received transjugular intrahepatic portosystemic shunt (TIPS) as treatment for cirrhosis. After analyzing the possible causes and incentives of hepatic encephalopathy by applying retrospective analysis, it was seen that hepatic encephalopathy was caused mostly by improper diet (85.7%). Proper dietary management is therefore essential to minimize the risk of such complications and support liver health.
General Post-Surgery Dietary Recommendations
After you’ve had surgery, what you eat can make a difference in how quickly you heal. Specifically, a diet that includes plenty of calories, protein, vitamins, and minerals can give you the strength and nutrients you need to recover quickly. It’s important to follow your surgeon’s specific dietary advice and discharge instructions. That said, all post-surgery diets generally have at least one thing in common: They involve eating enough nutritious foods to help your body recover. In addition, following a good post-surgery diet also means knowing which foods to avoid.
Specific Dietary Guidelines After TIPS
Protein Intake
Immediately following the procedure, your doctor may recommend eating no more than 20 grams of protein a day for 3 days to lower the risks for postoperative side effects. Protein plays a vital role in healing since it helps the body rebuild tissue after surgery. Red meats have protein, but they tend to be high in saturated fat, which is not good for our heart health. If having red meats, try to choose a lean cut such as flank steak or strip steak, or cutting off the fat marbling to reduce the saturated fat. Lean sources of protein are better options. Try choosing seafood and fish; lean meats like chicken or turkey and pork; and non-meat proteins like eggs, tofu, beans and other legumes. Including reduced fat and no fat dairy products, such as milk, yogurt and cottage cheese can help you get enough protein after surgery. If you experience constipation when consuming dairy products before surgery we do not recommend including dairy products after surgery.
Sodium Restriction
Your doctor may advise you as to a healthy post-TIPS procedure diet. Examples of interventions include a low-protein diet and low-sodium diet.
Fiber Intake
Many people have constipation after surgery. Often it can be a side effect of anesthesia or pain medicine. Since constipation can put stress on an incision - besides being painful - I warn my patients about this risk and strongly encourage them to do everything they can to help prevent or manage constipation. Eat high-fiber foods. Whole grains pack a lot of fiber, which helps keep food moving through your digestive tract. Examples of whole grains include whole-grain breads and pastas; cereals such as oatmeal and cream of wheat; and barley, bulgur, quinoa, and brown rice. Vegetables and fruits are a good source of fiber as well. Increase the available fiber by having whole fruits or vegetables, such as apple slices with the skin on. You can choose produce that is fresh, frozen, or canned. If choosing canned vegetables, try to use low sodium options, or rinse them before cooking.
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Fluid Intake
Drink more liquids, such as water, herbal and decaffeinated teas, and other unsweetened beverages. Try to avoid caffeinated drinks, or restrict yourself to an 8oz serving per day to ensure that you are meeting your fluid goals. Maintaining adequate fluid intake helps to maintain bowel regularity. Set a goal of at least 64oz per day, unless otherwise advised by your surgeon.
Soft Food Diet
This diet provides very soft foods for your child. The foods are easy to chew and swallow. Your child needs a special diet for about a month. Follow this diet until your child’s surgeon says it is ok for your child to eat a regular diet.
- Tell your child to take small bites and chew food well. Cut all food into small pieces.
- Have your child take a few sips of liquid after every few bites of food.
- Give your child smaller meals but offer them more often.
- Do not let your child eat hard or crunchy foods.
Foods to Avoid
- Fatty foods: Avoid fatty foods that are more likely to cause constipation, such as cheeses and full-fat dairy products, French fries, and red meats.
- Fried food: Limit your intake of fried food.
- Alcohol: You may feel like celebrating getting out of the hospital, but you shouldn’t toast to your good health with alcohol! One reason? Alcohol can dehydrate your body, which may hamper healing. In addition, you should never drink alcohol if you’re taking pain medication.
Tips for Managing Diet After TIPS
- Read labels: If you plan on including processed foods after surgery, try to choose items that are low in salt, low in sugar, and high in protein.
- Consult with a dietitian: As a registered dietitian at Temple, I am often asked what people should or shouldn’t eat after surgery. One of the first things I tell people is that it’s important to follow your surgeon’s specific dietary advice and discharge instructions. Let your doctor, nurse, or other member of your post-surgery team know about any problems you’re having with eating.
- Small, Frequent Meals: Some people don’t feel like eating after surgery. They may not be hungry, or they may feel nauseous. Another strategy you can use when you’ve lost your appetite: add calories to the foods you normally eat. For example, instead of eating plain apple slices, try spreading some peanut butter on them. Some patients find that it is easier to tolerate liquid calories rather than eating solid meals. Try making smoothies at home with yogurt or non-dairy milk, peanut butter, and fruit! Remember to use whole fresh or frozen fruit to increase the fiber available in the smoothie.
- Preventing Constipation: Eat high-fiber foods. Whole grains pack a lot of fiber, which helps keep food moving through your digestive tract.
Other Considerations
- Medications: Tell your doctor about all the medications you take, including herbal supplements.
- Pregnancy: Tell your doctor if they are pregnant. Doctors will not perform many tests during pregnancy to avoid exposing the fetus to radiation. If an x-ray is necessary, the doctor will take precautions to minimize radiation exposure to the baby.
- Fasting: Your doctor will likely tell you not to eat or drink anything after midnight before your procedure.
Benefits vs. Risks of TIPS
As with any procedure, the TIPS procedure isn’t without side effects. Those who need the procedure are often very sick, which can increase the risk for side effects. A doctor should thoroughly explain the pros, cons, and risks of the procedure.
The fatality rate for a TIPS procedure is less than 1%, and the 30-day mortality rate is less than 3%. This means that after 30 days, 97% of people who underwent the procedure are alive.
The most common causes of death from the TIPS procedure are organ failure and hemobilia, or bleeding within the biliary system.
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Potential Risks
- Any procedure that penetrates the skin carries a risk of infection.
- There is a very slight risk of an allergic reaction to the contrast material used for venograms.
- Any procedure that places a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
- Patients with more advanced liver disease are at greater risk for worsening liver failure after TIPS. If your liver failure is severe, a TIPS may not be recommended and a different procedure may be needed to control your symptoms.
- Patients with severe liver disease are also at risk for encephalopathy, which is an alteration of normal brain function that can lead to confusion due to buildup of toxic substances in the bloodstream ordinarily removed by the liver. Encephalopathy can be treated with certain medications, a special diet, or by revising the TIPS.
Life Expectancy and Liver Transplant
A TIPS procedure can lower a person’s mortality compared with no intervention. Those who don’t undergo TIPS procedures but may be candidates have a mortality rate of 40% compared with those who undergo TIPS procedures, whose mortality rate is between 20% and 35%. Over time, the TIPS procedure can lower your liver’s functioning. The effect is likely due to less blood flow to your liver. The underlying reasons you needed a TIPS procedure and undergoing the TIPS procedure itself may be indications for a liver transplant. However, there are many factors that impact if you need a liver transplant. You should discuss if you’re a candidate given your age and overall health.