Resistant ascites and hepatic encephalopathy in a patient on the liver transplant waiting list

Introduction. Treatment of a patient with liver cirrhosis involves achieving maximum control over its complications. Objective of the Study. To demonstrate a staged approach to the management of a patient on the liver transplantation waiting list using a clinical case example. Discussion. Minimally invasive surgical techniques opens up new therapeutic opportunities for patients with liver cirrhosis. The implementation of TIPS (Transjugular Intrahepatic Portosystemic Shunt) has proven to be an effective method for managing refractory ascites. The exacerbation of hepatic encephalopathy in the postoperative period following TIPS is an anticipated adverse effect that must be considered when planning the intervention. Screening examinations for the diagnosis of hepatic encephalopathy should be regularly conducted for all patients who have undergone TIPS. Treatment of TIPS-associated hepatic encephalopathy aims to reduce the production and absorption of ammonia or increase its elimination. It should be initiated in the early days following the procedure. Since intestinal sanitation is a pathogenetically justified objective of this therapy, the use of antibacterial agents to suppress excessive bacterial growth in these patients becomes the cornerstone of the treatment protocol. Conclusions. TIPS is an effective treatment method for refractory ascites, while the risk of developing hepatic encephalopathy should be taken into account when implementing early postoperative period management interventions.