scholarly journals The significance of hepatopulmonary syndrome in liver transplantation

2004 ◽  
Vol 51 (3) ◽  
pp. 67-71
Author(s):  
Djordje Culafic ◽  
Vladimir Djukic ◽  
Rada Jesic
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Hepatopulmonary Syndrome ◽  
Blood Gases ◽  
Poor Response ◽  
Vascular Abnormality ◽  
Pulmonary Scintigraphy ◽  
Oxygen Inhalation ◽  
Arterial Blood ◽  
Diagnostic Role

The objective of the study is to determine the diagnostic role of pulmonary functional tests and perfusion pulmonary scintigraphy for quantifying the oxygenation and vascular abnormality in patients with liver cirrhosis. The prospective study included 70 patients with liver cirrhosis. Arterial blood gases analysis were performed in both supine and sitting positions while inhaling room air, and 15 minutes after exposure of hyperoxic mixture. Perfusion pulmonary scintigraphy using albumin macroagregate labelled with radioactive technetium (99mTc- MAA) was performed for the visualisation of intrapulmonary vascular dilatation. The diagnosis of hepatopulmonary syndrome was made in 10 (14.3%) patients. The patients with hepatopulmonary syndrome had severe hypoxemia (Pa,O2 7.41 +1.81 kPa), and poor response to 100% oxygen inhalation (Pa,O2 21.07 + 14.41 kPa) and higher alveolo-arterial gradient (5.73 + 2.65 kPa). Radioisotope marker 99mTc-MAA skipped intrapulmonary circulation in all patients with HPS and in no one without pulmonary vascular dilatations. The combined approach of 100% inspired oxygen and perfusion pulmonary scintigraphy may identify early oxygenation disorders and alter the priority for liver transplantation, especially in view of potential syndrome resolution.

scholarly journals ARE THE SPIDER ANGIOMAS SKIN MARKERS OF HEPATOPULMONARY SYNDROME?

2013 ◽  
Vol 50 (3) ◽  
pp. 175-179 ◽  
Author(s):  
Americo de Oliveira SILVERIO ◽  
Dayanne Cintra GUIMARAES ◽  
Larissa Fernanda Queiroz ELIAS ◽  
Erika Oliveira MILANEZ ◽  
Silvano NAVES
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Contrast Echocardiography ◽  
Laboratory Data ◽  
Hepatopulmonary Syndrome ◽  
Blood Gases ◽  
Vascular Changes ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Significant Difference

Context Hepatopathies can significantly influence both veins and arteries, these changes may cause some cutaneous stigmas, such as spider angioma (SA) and some systemic vascular changes, such as those observed in hepatopulmonary syndrome (HPS). Based on this common pathophysiological root we can assume that the SA can be skin markers of HPS. Objective The objective of this study is to assess whether there is a relationship between the presence of SA and HPS. Methods Records of 40 patients with liver cirrhosis who underwent contrast echocardiography were evaluated, in which we researched the description of SA, physical examination, and other clinical and laboratory data. For diagnosis of HPS we use these signs of the disease: presence of liver disease (cirrhosis in the case), abnormalities in gas exchange by arterial blood gases, and evidence of pulmonary vasodilations by the contrast echocardiography. Results The SA were found in 21/40 (52.5%) patients and hepatopulmonary syndrome in 9/40 (22.5%). The HPS was observed in 8/21 (38.1%) of patients with SA and 1/19 (5.3%) patients were without this sign (P<0.01). We found no statistically significant difference between the SA and the presence of HPS with sex or age. Patients with SA had a higher hypoxemia [PaO2 84.8 ± 11.5 mmHg and 19.8 ± 14.7 mmHg alveolar-arterial gradient of oxygen (AAG)] than those without SA (PaO2 90.8 ± 10.7 mmHg and 10.9 ± 11.7 AAG mmHg) (P<0.05). Conclusion Our findings show a correlation between the presence of SA and HPS, suggesting that the SA may be cutaneous markers of HPS.

scholarly journals Hepatopulmonary Syndrome with Finger Clubbing

2021 ◽  
Vol 96 (3) ◽  
pp. 236-240
Author(s):  
Ho Kyung Kim ◽  
Won Ki Kim ◽  
Joo Han Kim ◽  
Jeong Woo Lee ◽  
Wook Jin Chung ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Physical Examination ◽  
Liver Transplant ◽  
Effective Treatment ◽  
Contrast Echocardiography ◽  
Hepatopulmonary Syndrome ◽  
Upright Position ◽  
Common Symptom ◽  
Arterial Oxygenation

Hepatopulmonary syndrome is a rare lung complication of liver cirrhosis, caused by pulmonary microvascular vasodilation that induces abnormal arterial oxygenation. Typical findings on physical examination are finger clubbing and cyanosis. Dyspnea is a common symptom and is worse in the upright position. Contrast echocardiography is a useful diagnostic test. Currently, the only effective treatment is liver transplantation. We report the case of a woman with cirrhosis who has hepatopulmonary syndrome with finger clubbing, confirmed by contrast echocardiography. The patient is waiting for a liver transplant.

scholarly journals The Relationship Between Airway Occlusion Pressure and Severity of liver Cirrhosis in Candidates for Liver Transplantation

2020 ◽  
Vol 12 (2) ◽  
pp. 111-115
Author(s):  
Delara Gholamipoor ◽  
Mohssen Nassiri-Toosi ◽  
Masumeh Azadi ◽  
Mehrnaz Asadi Gharabaghi
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Liver Disease ◽  
Pulmonary Function Tests ◽  
Meld Score ◽  
Respiratory Drive ◽  
Occlusion Pressure ◽  
Arterial Blood ◽  
End Stage ◽  
The Relationship

BACKGROUND End-stage cirrhosis is an irreversible condition, and liver transplantation is the only treatment option in for the affected patients. Respiratory problems and abnormal breathing are common findings among these patients. In this study, for the first time, we examined the relationship between the severity of liver cirrhosis and respiratory drive measured by mouth occlusion pressure (P0.1). METHODS This was a cross-sectional study conducted on 50 candidates for liver transplantation who were referred to the pulmonary clinic of Imam Khomeini Hospital for pre-operative pulmonary evaluations. Arterial blood gas analysis (ABG), pulmonary function tests, and measurement of P0.1 were performed for all patients. The severity of liver disease was assessed using the Model for End-Stage Liver Disease (MELD) score. RESULTS The median P0.1 was 5 cm H2 O. P0.1 was negatively associated with PaCO2 (r = -0.466, p = 0.001) and HCO3 - (r = -0.384, p = 0.007), and was positively correlated with forced expiratory volume at 1s (FEV1 )/ forced vital capacity (FVC) (r = 0.282, p = 0.047). There was a strong correlation between P0.1 and MELD score (r = 0.750, p < 0.001). Backward multivariate linear regression revealed that a higher MELD score and lower PaCO2 were associated with increased P0.1. CONCLUSION High levels of P0.1 and strong direct correlation between P0.1 and MELD score observed in the present study are suggestive of the presence of abnormal increased respiratory drive in candidates for liver transplantation, which is closely related to their disease severity.

Diagnostic Role of Blood Tumor Markers in Predicting Hepatocellular Carcinoma in Liver Cirrhosis Patients Undergoing Liver Transplantation

2016 ◽  
Vol 21 ◽  
pp. 660-667 ◽  
Author(s):  
Younghwan Kim ◽  
Yo-Han Park ◽  
Shin Hwang ◽  
Ki-Hun Kim ◽  
Chul-Soo Ahn ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Tumor Markers ◽  
Diagnostic Role

scholarly journals Hepatopulmonary Syndrome. Review

2021 ◽  
Vol 6 (3) ◽  
pp. 45-52
Author(s):  
V. V. Potii ◽  
◽  
V. T. Kiriienko ◽  
E. I. Glukhova ◽  
O. S. Kunickaya ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Hepatopulmonary Syndrome ◽  
Gas Analysis ◽  
Arterial Oxygen ◽  
Common Symptom ◽  
Portopulmonary Hypertension ◽  
Oxygen Gradient ◽  
Arterial Blood ◽  
Intrapulmonary Shunting

Liver cirrhosis is often accompanied by complications from the pulmonary system. These include hydrothorax, portopulmonary hypertension and hepatopulmonary syndrome. Hepatic hydrothorax affects about 6-10% of patients with end-stage disease, which results in the passage of ascetic fluid into the pleural space through diaphragm defects. The common cause of the hepatopulmonary syndrome and portopulmonary hypertension is portal hypertension and portosystemic shunting, indicating that vasoactive and angiogenetic factors originating from the liver normally control the pulmonary circulation. Portopulmonary hypertension is like pulmonary arterial hypertension, which develops against the background of portal hypertension as a result of chronic liver disease or without other causes of increased pressure in the pulmonary vessels. The prevalence of portopulmonary hypertension ranges from 2% to 8.5% among patients with portal hypertension and is associated with a poor prognosis. Hepatopulmonary syndrome is characterized by intrapulmonary dilatation of microvessels, which causes intrapulmonary shunting and leads to impaired gas exchange in liver diseases, and is associated with a decrease in the quality and duration of life in patients with cirrhosis. Nitric oxide overproduction and angiogenesis seem to be the hallmarks of a complicated pathogenetic mechanism, leading to intrapulmonary shunting and ventilation-perfusion mismatch. A classification of hepatopulmonary syndrome according to the severity of hypoxemia has been suggested. Hepatopulmonary syndrome includes a triad: hepatic dysfunction and / or portal hypertension, dilatation of intrapulmonary vessels, and increased alveolar-arterial oxygen gradient. The prevalence of hepatopulmonary syndrome varies depending on the study groups from 5% to 30%. The most common symptom of the complication is shortness of breath, but in most cases, hepatopulmonary syndrome is asymptomatic. A decrease in oxygen saturation less than 96% corresponds to a decrease in PaO2<70 mm Hg and testifies to the possible development of hepatopulmonary syndrome. In the case of a positive screening, the patient should undergo arterial blood gas analysis, which helps to determine PaO2 and alveolar to arterial oxygen gradient. Conclusion. Contrast-enhanced echocardiography with agitated saline is the gold standard in the diagnosis of intrapulmonary dilatation. The only effective treatment for hepatopulmonary syndrome is liver transplantation. Complete recovery of hepatopulmonary syndrome after liver transplantation is observed within a year in most patients with cirrhosis and hepatopulmonary syndrome

scholarly journals Triagem da síndrome hepatopulmonar: oximetria de pulso ou gasometria arterial?/ Hepatopulmonary syndrome screening: pulse oximetry or arterial gasometry?

2019 ◽  
Vol 64 (3) ◽  
pp. 184
Author(s):  
Cláudia Debona Mocelin ◽  
Marina Ribeiro Rocha ◽  
Mariana Poltronieri Pacheco
Keyword(s):  
Liver Transplantation ◽  
Pulse Oximetry ◽  
Hepatopulmonary Syndrome ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Cirrhotic Patients

Objetivo: Avaliar se a realização rotineira da gasometria arterial em todos os pacientes cirróticos pode ser substituída pela oximetria de pulso isolada para a triagem de SHP. Material e métodos: Estudo observacional, individuado e transversal do tipo inquérito, por meio da análise dos prontuários dos pacientes do ambulatório de gastroenterologia e hepatologia do Hospital Santa Casa de Misericórdia de Vitória, localizado na cidade de Vitória - ES, e por meio da análise da gasometria arterial destes pacientes. Como critérios para o diagnóstico de cirrose, foram utilizados a história clínica, o exame físico, a análise laboratorial e pelo menos um exame de imagem.  Resultados: A amostra teve 75,4% de homens, com etiologia alcoólica sendo mais prevalente (53%). A idade média foi de 54 anos, não tendo correlação com a PaO2 (p = 0,754) e com a AaO2 (p = 0,574). A prevalência de pacientes Child A foi de 88,2% e Child B de 11,8%. A maioria (88,2%) dos pacientes apresentaram gradiente AaO2 ≥ 20 mmHg, compatível com critério diagnóstico gasométrico de SHP. Discussão: Não foi observada correlação significativa entre a oxigenação sanguínea medida pela gasometria arterial e pela oximetria de pulso. Pacientes com PaO2 < 60 mmHg apresentaram SatO2 mínima de 93% e mediana de 97%, DP 2,2, comparado com mínima de 85% e mediana de 87%, DP 3,9,  nos pacientes com níveis ≥ 60 mmHg (p = 0,827). Portanto, nota-se que a SatO2 medida pela oximetria de pulso não é um bom parâmetro para triagem de SHP nos pacientes cirróticos. Conclusões: A gasometria arterial é indispensável em todos os pacientes cirróticos para triagem da Síndrome Hepatopulmonar, independente da classe funcional, não podendo ser substituída pela oximetria de pulso. Tal conduta visa acelerar o diagnóstico dessa síndrome, considerando a inexistência de correlação entre os critérios diagnósticos gasométricos já estabelecidos e os valores obtidos na oximetria de pulso e no escore Child-Pugh. Tendo em vista que a Síndrome Hepatopulmonar é uma indicação de transplante hepático, seu diagnóstico precoce pode adiantar o processo, melhorando a resposta terapêutica e a sobrevida dos pacientes.Descritores: Síndrome hepatopulmonar, Cirrose hepática, Transplante de fígado, Oximetria, GasometriaABSTRACTObjective: To evaluate whether routine arterial blood gas analysis in all cirrhotic patients can be replaced by isolated pulse oximetry for HPS screening. Material and methods: Observational, individualized and cross-sectional study, by analyzing the medical records of patients from the gastroenterology and hepatology outpatient clinic of the Santa Casa de Misericórdia de Vitória Hospital, located in the city of Vitória - ES, and by analyzing the laboratory results of the arterial blood gases of these patients. The criteria for the diagnosis of cirrhosis were clinical history, physical examination, laboratory analysis and at least one imaging exam. Results: A total of 75.4% of the sample consisted of males, with alcoholic etiology being more prevalent (53%). The mean age was 54 years, with no correlation with PaO 2 (p = 0.754) and AaO 2 (p = 0.574). The prevalence of Child A patients was 88.2% and of Child B was 11.8%. The majority (88.2%) of the patients presented a AaO2 gradient ≥ 20 mmHg, compatible with HPS gasometric diagnostic criteria.  Discussion: No significant correlation was observed between blood oxygenation as measured by arterial blood gas and pulse oximetry. Patients with PaO2 <60 mmHg had a minimum SatO2 of 93% and a median of 97%, SD 2.2, compared with a minimum of 85% and a median of 87%, SD 3.9, in patients with levels ≥ 60 mmHg (p = 0.827). Therefore, it is noted that SatO2 measured by pulse oximetry is not a good parameter for screening for SHP in cirrhotic patients. Conclusion: Arterial blood gas analysis is indispensable in all cirrhotic patients in screening for Hepatopulmonary Syndrome, regardless of functional class, and cannot be replaced by pulse oximetry. Such conduct aims to accelerate the diagnosis of this syndrome, considering the inexistence of correlation between the already established gasometric diagnostic criteria and the values obtained in pulse oximetry and Child- Pugh score. Since the existence of Hepatopulmonary Syndrome is an indication for liver transplantation, early diagnosis may accelerate the process, improving therapeutic response and survival in patients.Keywords: Hepatopulmonary syndrome, Liver cirrhosisc Liver transplantation, Oximetry, Gasometry

scholarly journals Hepatopulmonary Syndrome Associated with Schistosomal Liver Disease

1997 ◽  
Vol 11 (5) ◽  
pp. 449-450 ◽  
Author(s):  
Mohamed Al-Moamary ◽  
Ibrahim Altraif
Keyword(s):  
Liver Disease ◽  
Contrast Echocardiography ◽  
Hepatopulmonary Syndrome ◽  
Blood Gases ◽  
Positive Contrast ◽  
Shortness Of Breath ◽  
Extensive Investigation ◽  
Arterial Blood Gases ◽  
Respiratory Complications ◽  
Arterial Blood

A 55-year-old man with schistosomal liver disease presented with shortness of breath, orthodeoxia, platypnea, cyanosis, marked digital clubbing and liver failure. Extensive investigation revealed no other etiology for liver disease apart from schistosomiases. The diagnosis of hepatopulmonary syndrome was based on clinical grounds, as well as abnormal arterial blood gases and positive contrast echocardiography. The patient underwent orthotopic liver transplantation, which was initially successful, but then died of respiratory complications and multi-organ failure on day 42 post-transplant. To the authors' knowledge this is the first report of hepatopulmonary syndrome associated with schistosomal liver disease.

Sign in / Sign up

Export Citation Format

Share Document