Hypoxemia in a patient with end-stage liver disease

Michael Gotway, Rachel H. Dotson, Samuel K. Dawn, J. W T Leung, Martha L. Warnock

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

A number of pulmonary conditions producing hypoxemia may affect patients with chronic liver disease. Among these conditions, hepatopulmonary syndrome (HPS) is common, with the estimated prevalence of HPS among patients with end-stage liver disease ranging from 4% to 29%. HPS is considered present when the triad of liver dysfunction and/or portal hypertension, intrapulmonary vascular dilatation, and abnormal arterial oxygenation are noted in the absence of intrinsic cardiopulmonary disease. The pathogenesis of HPS is still unclear but is likely related to the effects of nitrous oxide and other vasoactive substances on the pulmonary vascular endothelium. HPS primarily affects the precapillary arterioles and capillaries in the lung bases, producing dilation of these vessels. These dilated vessels may produce hypoxemia through a combination of several mechanisms, including true anatomic shunts, ventilation-perfusion mismatch, and diffusion-perfusion defects. Chest radiographic imaging findings of HPS may be subtle and primarily consist of basilar reticular and nodular opacities. Thoracic CT often shows dilated peripheral pulmonary arteries with normal central pulmonary arteries. Pulmonary angiography may show dilated peripheral pulmonary arteries and early venous filling. 99mTechnetium-labeled macroaggregated albumin scans may show systemic embolization of radioactive tracer. Treatment of HPS consists of supplemental oxygen and, in severe cases, orthotopic liver transplantation.

Original languageEnglish (US)
Pages (from-to)61-66
Number of pages6
JournalClinical Pulmonary Medicine
Volume12
Issue number1
DOIs
StatePublished - Jan 2005
Externally publishedYes

Fingerprint

Hepatopulmonary Syndrome
End Stage Liver Disease
Pulmonary Artery
Lung
Liver Diseases
Dilatation
Thorax
Perfusion
Radioactive Tracers
Vascular Endothelium
Nitrous Oxide
Arterioles
Portal Hypertension
Hypoxia
Liver Transplantation
Blood Vessels
Ventilation
Albumins
Angiography
Chronic Disease

Keywords

  • Cirrhosis
  • Computed tomography
  • Hepatopulmonary syndrome
  • Hypoxemia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Hypoxemia in a patient with end-stage liver disease. / Gotway, Michael; Dotson, Rachel H.; Dawn, Samuel K.; Leung, J. W T; Warnock, Martha L.

In: Clinical Pulmonary Medicine, Vol. 12, No. 1, 01.2005, p. 61-66.

Research output: Contribution to journalArticle

Gotway, Michael ; Dotson, Rachel H. ; Dawn, Samuel K. ; Leung, J. W T ; Warnock, Martha L. / Hypoxemia in a patient with end-stage liver disease. In: Clinical Pulmonary Medicine. 2005 ; Vol. 12, No. 1. pp. 61-66.
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