Introduction
Malnutrition
Definition
Pathogenesis
Management
Outcome
Infections and Immunity
Definition
Diagnosis
Pathogenesis
Management
Outcome
Neurological
Pulmonary
Hepatopulmonary Syndrome
Definition
Hepatopulmonary Syndrome | Portopulmonary Hypertension | |
---|---|---|
Definition | The triad of abnormal arterial oxygenation caused by intrapulmonary vascular dilatations (IPVDs) in the setting of liver disease, portal hypertension, or congenital portosystemic shunts | Portopulmonary hypertension (PPHTN) refers to pulmonary arterial hypertension that is associated with portal hypertension |
Diagnostic criteria | Criteria 1: Chronic liver disease Criteria 2: A-aDO2 ≥15 mmHg or ≥20 mmHg, or ≥ to the age- adjusted value1 Criteria 3: Intrapulmonary vascular dilatation at CE-TTE or 99mTc- MAA | Criteria 1: Portal hypertension (15 mmHg, or portocaval gradient >5 mmHg) Criteria 2: mPAP >25 mmHg and mPAOP <15 mmHg mPAP - mPAOP (transpulmonary gradient) >10 mmHg PVR >240 dyn.s.cm-5 = 3 UI WOOD |
Severity grading | Mild: ≥80 PaO2, mmHg Moderate: ≥60 and <80 PaO2, mmHg Severe: ≥50 and <60 PaO2, mmHg Very severe: <50 PaO2, mmHg | Mild: 25 mmHg < mPAP <35 mmHg Moderate: 35 mmHg ≤ mPAP <45 mmHg Severe: mPAP ≥45 mmH |
Prevalence | 10%-30% in those with end stage liver disease | 6% in those with end stage liver disease |
Pathophysiology | Both conditions result from a lack of hepatic clearance of vasoactive substances produced in the splanchnic territory. | Both conditions result from a lack of hepatic clearance of vasoactive substances produced in the splanchnic territory. |
Complications | Intrapulmonary shunts with hypoxemia | Elevated pulmonary pressure and right ventricular dysfunction |
Treatment | Liver transplant curative in majority in 6–12 mo | Unpredictable outcome |