Which of the following complications can arise after a Trans jugular Intrahepatic Portosystemic Shunt (TIPS) procedure?

A Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a procedure used to manage complications of portal hypertension, especially in clients with advanced liver disease such as cirrhosis. It creates a channel between the portal vein and hepatic vein to reduce portal pressure and decrease problems such as variceal bleeding and refractory ascites. Although effective, this diversion of blood flow reduces the liver’s ability to filter toxins from the bloodstream. As a result, one of the most common complications after TIPS is the development of hepatic encephalopathy. Rationale: A. Cholecystitis is inflammation of the gallbladder and is not a typical complication directly associated with a TIPS procedure. It is more commonly related to gallstones, infection, or biliary stasis rather than portal venous shunting. While clients with liver disease may have multiple abdominal issues, cholecystitis is not the expected post-TIPS complication being assessed here. B. Biliary obstruction is not a common complication of TIPS because the procedure primarily involves vascular structures rather than the biliary tract. Although rare technical complications may affect nearby structures, routine concern after TIPS is not obstruction of bile flow. Monitoring usually focuses more on bleeding, shunt patency, and neurologic changes rather than biliary blockage. C. Ascites is often one of the reasons TIPS is performed rather than a complication caused by it. By lowering portal venous pressure, TIPS helps reduce fluid accumulation in the abdomen and is commonly used for refractory ascites management. Persistent or worsening ascites may indicate shunt dysfunction, but ascites itself is not the classic expected complication after the procedure. D. Hepatic encephalopathy is a common complication after TIPS because blood from the portal circulation bypasses the liver’s detoxification process. Substances such as ammonia are not adequately metabolized and can accumulate in the bloodstream, affecting brain function. Clients may develop confusion, altered mental status, asterixis, and decreased level of consciousness, requiring close neurologic monitoring.