Last update: 12/17/16 (scroll down)

Our nail biting roller coaster continues; the morning of 12/9/10 seemed to look good, blood pressure meds dropped, some activity in the right eye, less fluid in the lungs; though things took a turn with internal gastric bleeding, profuse amounts of blood coming from dad’s gastronomy (gi) tube, a tube inserted through the nose reaching all the way to the small intestine.  On 12/10/16, blood began gushing from dad’s nose and mouth.

One serious complication of portal hypertension is variceal bleeding.

3 liters of blood had bled out from dad’s stomach and emptied out the gi tube to canisters behind the bed.  Numerous transfusions and platelets had been administered to replenish blood lost.

TIPSS, Transjugular Intrahepatic Porto-Systemic Shunt

Doctor’s performed a TIPSS, Transjugular Intrahepatic Porto-Systemic Shunt procedure 12/9/10 on my dad to release pressure on the liver by creating new connections between two blood vessels in the liver.  (read to the end to learn of outcome)

Transjugular intrahepatic portosystemic shunt (TIPS)

Transjugular intrahepatic portosystemic shunt (TIPS) – Credit: academic.amc.edu

When portal hypertension occurs, there may be bleeding from veins of the stomach, esophagus, or intestines (variceal bleeding).

This procedure allows blood to flow better in the liver, stomach, esophagus, and intestines, and then back to the heart.

During the procedure:

  • The doctor inserts a catheter (a flexible tube) through the skin into a vein in the neck. This vein is called the jugular vein. On the end of the catheter is a tiny balloon and a metal mesh stent (tube).
  • Using an x-ray machine, the doctor guides the catheter into a vein in the liver.
  • Dye (contract material) is then injected into the vein so that it can be seen more clearly.
  • The balloon is inflated to place the stent.
  • The doctor uses the stent to connect the portal vein to one of the hepatic veins.
  • At the end of the procedure, the portal vein pressure is measured to make sure it has gone down.
  • The catheter with the balloon is then removed.
  • After the procedure, a small bandage is placed over the neck area. There are usually no stitches.
  • The procedure takes about 60 to 90 minutes to complete.

This new pathway will allow blood to flow better. It will ease pressure on the veins of the stomach, esophagus, intestines, and liver.

Credit: 
medlineplus.gov/ency/article/007210.htm

The TIPSS, Transjugular Intrahepatic Porto-Systemic Shunt procedure, performed 12/9/10, seemed to hold dad up for the most of the next day, 12/10/16, however, around 5pm, blood began to gush from his nose and mouth.  About 2-3 liters of blood this time.

Esophagogastroduodenoscopy with Hemostasis

Nurses proceeded to call gastroenterology doctors, who proceeded with an esophagogastroduodenoscopy with hemostasis, a process which causes bleeding to stop through inserting a balloon (Sengstaken Blakemore tube) in the stomach to seal possible variceal bleeding.

Sengstaken Blakemore tube

Sengstaken Blakemore tube

The balloon (Sengstaken Blakemore tube) is left in the stomach with constant measured pressure for up to 3 days in an effort to seal the bleeding.

12/11/16 12am: Despite the procedures, bleeding seems to continue.

Dad will be taken to get a CT Scan to check for any new sources of bleeding.

Dad out for CT Scan

Dad out for CT Scan

7am: CT Scan showed no bleeding in liver and no new variceal bleeding.  Bleeding seems to be under control as a result of esophagogastroduodenoscopy with hemostasis.  Coagulating products continue to be administered.

4pm: Esophogeal balloon was deflated for progress check on bleeding.  No bleeding so far.  Gastric balloon remains inflated in stomach.

12/12/16

4pm: Gastric balloon was deflated and left in stomach just in case.  Blood products continuously given.  Bleeding seems under control for now.  Nitric Oxide machine removed.

5pm: Dad has a blood infection.  Central, IV and dialysis lines replaced.  Bactrim antibiotic currently being administered.

6pm: Mom was asked to go to waiting room due to bleeding; we had thought the bleeding started again in the stomach.  After an hour, she was called back to find out the bleeding was due to old dialysis line. (Wooh, what are relief it was!)

Day 25 in 8th floor ICU, balloon deflated

12/13/16

New antibiotic, bactrim, put in the mix, due to blood infection.  A little bleeding from stomach, though may be old blood.

9:30pm: Balloon removed.  Minimal bleeding, possibly old blood

12/14/16

Day 8 of antibiotics.  Day 27 in liver ICU.  Not much change in lungs and oxygenation.  Aspergilles and Candida persists and are still being treated.  NG tube will be put back to allow for meds to be administered that way.  No bleeding for now.

12/15/16

Dad’s lung condition continues to deteriorate.  Aspergillus and ARDS taking over his lungs.  Oxygenation in the 80s.

12/16/16

Dad’s lung condition again continues to deteriorate.  Oxygenation at low 80s.

12/17/16

Day 30 in liver ICU.  Dad’s lung condition again continues to deteriorate.  Oxygenation hitting the 70’s.  By 9am, Atrial fibrillation starts.  Before noon, oxygen drops to low levels.  Dad is surrounded by family holding and praying for entry to heaven.

To the most amazing dad I could ask for, my hero, my mentor, my advisor, my biggest cheerleader, who supported me in everything in life, thank you for being the outstanding person that you were, for loving your family and friends unconditionally, for being a positive influence and role model to everyone around you, for being such an amazing dad, husband, grandfather, brother, uncle, son in law, cousin, friend, and man of God; for always smiling and laughing, and for being the positive force you were even in suffering, for staying so strong and fighting to live for your family each and every day.  Thank you God for blessing us with a good life, made possible by this man.

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