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Case
A 76 year old female with NASH is scheduled for a TIPS procedure. NASH has resulted in endstage liver disease with some associated chronic kidney disease. She is currently undergoing semi-weekly percutaneous pericentesis. She is unable to take diuretics because of low blood pressures. She has a strong heart and walked 2 miles to the hospital that morning for the procedure. Today's EKG shows possible left anterior fascicle block. Echo 1 month prior 70% EF, mild MR/TR. No tobacco/alcohol/drugs.
BP 86/62. HR 93. SpO2 100% on RA. These are her normal vitals.
Physical shows grossly distended belly with fluid wave. No edema in legs. No jaundice. Lungs are clear. Heart sounds normal. Airway looks decent. She is a very pleasant lady with great family there to support her.
Today's Hgb 12.5, platelets 150, INR 1.2, Na 130. Creatinine 1.3.
Is there anything else you would like to know?
What is your plan? What would you be watching out for.
(There are several more parts to this story)
A 76 year old female with NASH is scheduled for a TIPS procedure. NASH has resulted in endstage liver disease with some associated chronic kidney disease. She is currently undergoing semi-weekly percutaneous pericentesis. She is unable to take diuretics because of low blood pressures. She has a strong heart and walked 2 miles to the hospital that morning for the procedure. Today's EKG shows possible left anterior fascicle block. Echo 1 month prior 70% EF, mild MR/TR. No tobacco/alcohol/drugs.
BP 86/62. HR 93. SpO2 100% on RA. These are her normal vitals.
Physical shows grossly distended belly with fluid wave. No edema in legs. No jaundice. Lungs are clear. Heart sounds normal. Airway looks decent. She is a very pleasant lady with great family there to support her.
Today's Hgb 12.5, platelets 150, INR 1.2, Na 130. Creatinine 1.3.
Is there anything else you would like to know?
What is your plan? What would you be watching out for.
(There are several more parts to this story)
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