In this educational overview, Ethan Weinberg, MD, breaks down the fundamentals of portal hypertension and when to consider TIPS (transjugular intrahepatic portosystemic shunt) in clinical practice. The discussion highlights how clinically significant portal hypertension (CSPH) is diagnosed using both invasive and non-invasive methods, and reviews first-line management with non-selective beta blockers like carvedilol. The video focuses on key indications for TIPS, including variceal bleeding and ascites, emphasizing growing evidence that earlier intervention can improve outcomes, reduce complications, and enhance survival in high-risk patients. It also touches on evolving strategies to optimize patient selection and minimize risks such as hepatic encephalopathy. This high-yield summary is designed for clinicians and advanced practice providers managing cirrhosis and its complications, offering practical insights into when and how to escalate care.