Contraindication of TIPSS is
**Core Concept**
Transjugular Intrahepatic Portosystemic Shunt (TIPSS) is a procedure used to relieve portal hypertension by creating a shunt between the hepatic vein and a branch of the portal vein. This procedure is indicated for patients with refractory ascites, variceal bleeding, and other complications of portal hypertension.
**Why the Correct Answer is Right**
The correct contraindication of TIPSS is **Bleeding Esophageal Varices (BEV) with active bleeding**. This is because TIPSS can increase the risk of re-bleeding in patients with active BEV. The mechanism behind this is that TIPSS can decrease the pressure in the portal vein, which can lead to a decrease in the blood flow to the varices, making them more susceptible to re-bleeding. Additionally, TIPSS may not be effective in controlling the bleeding in patients with active BEV, and it may even worsen the situation.
**Why Each Wrong Option is Incorrect**
* **Option A:** Ascites is actually an indication for TIPSS, not a contraindication. TIPSS can help to relieve refractory ascites by reducing portal pressure.
* **Option C:** Hepatorenal syndrome (HRS) is a complication of advanced liver disease, and TIPSS can be used to treat HRS in some cases. However, TIPSS is not a contraindication for HRS.
* **Option D:** Liver cirrhosis is a common indication for TIPSS, and the procedure can be effective in relieving portal hypertension and improving symptoms in patients with liver cirrhosis.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that TIPSS is not a substitute for endoscopic or surgical treatment of variceal bleeding. Patients with active BEV should be stabilized with endoscopic or surgical treatment before considering TIPSS.
**Correct Answer: D. Liver cirrhosis is not a contraindication for TIPSS.**