Hepatopulmonary Syndrome

The hepatopulmonale syndrome is characterized by hypoxemia due to pulmonary microvascular vasodilation in patients with portal hypertension. , Dyspnea and hypoxemia worsen if the patient is in an upright position.

The hepatopulmonale syndrome results from the formation of microscopic arteriovenous dilatation in the lungs of patients with chronic liver disease. The pathogenesis is unknown, but the disease is to come by increased hepatic production or reduced hepatic degradation of vasodilators about. The vessel dilation causes a relative hyperperfusion in relation to ventilation, leading to hypoxemia, especially because patients have an increased cardiac output due to systemic vasodilation. Since the lesions often predominate in the basal lung sections that hepatopulmonale syndrome Platypnoe (dyspnea) and can Orthodesoxämie (hypoxemia) cause, which occur when the patient is in a seated or upright position and make amends back in a reclining posture. Most patients also have characteristic findings of chronic liver disease such as spider nevi. Approximately 20% of patients show only pulmonary symptoms.

The hepatopulmonale syndrome is characterized by hypoxemia due to pulmonary microvascular vasodilation in patients with portal hypertension. , Dyspnea and hypoxemia worsen if the patient is in an upright position. The hepatopulmonale syndrome results from the formation of microscopic arteriovenous dilatation in the lungs of patients with chronic liver disease. The pathogenesis is unknown, but the disease is to come by increased hepatic production or reduced hepatic degradation of vasodilators about. The vessel dilation causes a relative hyperperfusion in relation to ventilation, leading to hypoxemia, especially because patients have an increased cardiac output due to systemic vasodilation. Since the lesions often predominate in the basal lung sections that hepatopulmonale syndrome Platypnoe (dyspnea) and can Orthodesoxämie (hypoxemia) cause, which occur when the patient is in a seated or upright position and make amends back in a reclining posture. Most patients also have characteristic findings of chronic liver disease such as spider nevi. Approximately 20% of patients show only pulmonary symptoms. Diagnosis pulse oximetry contrast echocardiography and sometimes other imaging methods A hepatopulmonary syndrome should be suspected in all patients with known liver disease who report dyspnea (esp. Platypnoe). Patients with such symptoms should receive a pulse oximetry. When symptoms are severe (z. B. dyspnea at rest), BGAs should be measured while the patient room air and 100% O2 inhales in order to determine the shunt fraction. Tips and risks when patients have portal hypertension and shortness of breath is relieved by lying that hepatopulmonale syndrome should be considered. A useful diagnostic test is the contrast echocardiography. Intravenously administered shaken microbubbles of brine, which are normally blocked by the lung capillaries, rapidly traverse the lungs and appear quickly (within 7 heartbeats) in the left atrium. Similarly, technetium-99m-labeled albumin may i.v. the lungs pass through and appear in kidneys and brain. In a diffuse pulmonary angiography tender or patchy vessel formation can be displayed. In general, angiography is only necessary in cases of suspected thromboembolism. Additional therapy O2 The main treatment consists of additional O2 against the symptoms. Other therapies such as Somatostatingabe to inhibit vasodilation are moderately successful only in some patients. A coil embolization is virtually impossible due to the number and size of lesions. Inhaled nitric oxide synthesis inhibitors could be a future treatment option. The hepatopulmonale syndrome can regress after liver transplantation or cure the underlying disease. The prognosis is poor without treatment (survival <2 years). Key points Patients with epatopulmonalem syndrome tend to have evidence of chronic liver disease and may be suffering from Platypnoe. If the diagnosis is suspected, a pulse oximetry must be carried out and ABG and imaging should be considered (eg. As contrast echocardiography). Treatment consists of administration of O2.

Health Life Media Team

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