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Hepatitis cirrhosis hepatopulmonary syndrome

Anand Puttappa, Kumaraswamy Sheshadri, Aurelie Fabre, Georgina Imberger, John Boylan, Silke Ryan, Masood Iqbal, Niamh Conlon
BACKGROUND Hepatopulmonary syndrome (HPS) is a pulmonary complication of advanced liver disease with dyspnea as the predominant presenting symptom. The diagnosis of HPS can often be missed due to its nonspecific presentation and the presence of other comorbidities. CASE REPORT We present an interesting case of an obese 43-year-old man who presented with progressive, unexplained hypoxemia and shortness of breath in the absence of any symptoms or signs of chronic liver disease. After extensive cardiopulmonary investigations, he was diagnosed with severe HPS as a result of non-alcoholic steatohepatitis (NASH) leading to cirrhosis...
January 2, 2017: American Journal of Case Reports
Mamatha Bhat, Bianca M Arendt, Venkat Bhat, Eberhard L Renner, Atul Humar, Johane P Allard
The intestinal microbiome (IM) is altered in patients with cirrhosis, and emerging literature suggests that this impacts on the development of complications. The PubMed database was searched from January 2000 to May 2015 for studies and review articles on the composition, pathophysiologic effects and therapeutic modulation of the IM in cirrhosis. The following combination of relevant text words and MeSH terms were used, namely intestinal microbiome, microbiota, or dysbiosis, and cirrhosis, encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal bleeding, hepatopulmonary syndrome, portopulmonary hypertension and hepatocellular carcinoma...
September 28, 2016: World Journal of Hepatology
Vijaya S Ramalingam, Sikandar Ansari, Micah Fisher
Cirrhosis, the twelfth leading cause of death, accounts for 1.1% of all deaths in the United States. Although there are multiple pulmonary complications associated with liver disease, the most important complications that cause significant morbidity and mortality are hepatopulmonary syndrome, hepatic hydrothorax, and portopulmonary hypertension. Patients with cirrhosis who complain of dyspnea should be evaluated for these complications. This article reviews these complications.
July 2016: Critical Care Clinics
Gaetano Bertino, Graziella Privitera, Francesco Purrello, Shirin Demma, Emanuele Crisafulli, Luisa Spadaro, Nikolaos Koukias, Emmanuel A Tsochatzis
Liver cirrhosis is a major cause of morbidity and mortality worldwide, mainly due to complications of portal hypertension. In this article, we review the current understanding on the pathophysiology, the diagnostic criteria and the available therapeutic options for patients with emerging hepatic syndromes in cirrhosis, namely the hepatorenal, hepato-adrenal and hepatopulmonary syndrome. The hepatorenal syndrome is a well-recognized complication of advanced cirrhosis and is usually associated with an accelerated course to death unless liver transplantation is performed...
October 2016: Internal and Emergency Medicine
Juan Cristóbal Gana, Carolina A Serrano, Simon C Ling
In patients with advanced liver disease with portal hypertension, portal-systemic collaterals contribute to circulatory disturbance, gastrointestinal hemorrhage, hepatic encephalopathy, ascites, hepatopulmonary syndrome and portopulmonary hypertension. Angiogenesis has a pivotal role in the formation of portal-systemic shunts. Recent research has defined many of the mediators and mechanisms involved in this angiogenic process, linking the central roles of hepatic stellate cells and endothelial cells. Studies of animal models have demonstrated the potential therapeutic impact of drugs to inhibit angiogenesis in cirrhosis...
May 2016: Annals of Hepatology
Caglar Cosarderelioglu, Arif M Cosar, Merve Gurakar, Aliaksei Pustavoitau, Stuart D Russell, Nabil N Dagher, Ahmet Gurakar
Portopulmonary hypertension is one of the main pulmonary conditions affecting patients with liver disease and/or portal hypertension. Other conditions include hepatopulmonary syndrome and hepatic hydrothorax. Portopulmonary hypertension is caused by pulmonary vasoconstriction and increased pulmonary vascular resistance. It develops as a result of portal hypertension with or without liver disease and is associated with a higher morbidity and mortality. However, portopulmonary hypertension is usually asymptomatic; the most common symptoms are dyspnea, fatigue, and peripheral edema...
April 2016: Experimental and Clinical Transplantation
Shyam Sunder Mahansaria, Senthil Kumar, Kishore G S Bharathy, Sachin Kumar, Viniyendra Pamecha
Dyskeratosis congenita is a multisystem genetic disorder. Although hepatic involvement is reported in about 7% of patients with dyskeratosis congenita, it is not well characterized and often attributed to hemochromatosis from frequent blood transfusions. A few case reports describe cirrhosis and hepatic cell necrosis in affected individuals in autosomal dominant pedigrees. Bone marrow failure and malignancies are the principal causes of death in dyskeratosis congenita. We describe the first case of living donor liver transplantation, in dyskeratosis congenita for decompensated cirrhosis with portal hypertension...
December 2015: Journal of Clinical and Experimental Hepatology
Jorge M Hurtado-Cordovi, Seth Lipka, Jaspreet Singh, Ghulamullah Shahzad, Paul Mustacchia
Hepatopulmonary syndrome (HPS) is a severe complication seen in advance liver disease. Its prevalence among cirrhotic patients varies from 4-47 percent. HPS exact pathogenesis remains unknown. Patient presents with signs/symptoms of chronic liver disease, and dypsnea of variable severity. Our patient is a 62 years old white male with a known history of chronic hepatitis C, cirrhosis, ascites, and hypothyroidism who presented to GI/liver clinic complaining of 1 episode BRBPR, and exacerbating dypsnea associated with nausea and few episodes of non-bloody vomit...
2011: Case Reports in Hepatology
José L Faustini-Pereira, Lucas Homercher-Galant, Eduardo Garcia, Ajácio Bandeira de Mello Brandão, Cláudio A Marroni
INTRODUCTION: Hepatopulmonary syndrome (HPS) is characterized by a clinical triad of liver disease and/or portal hypertension, intrapulmonary vascular dilatation and abnormal arterial oxygenation. These conditions can worsen muscle strength, exercise capacity and functionality in the affected population. OBJECTIVE: The objective of this study was to compare exercise capacity, functional condition and respiratory muscle strength in cirrhotic patients diagnosed with HPS and cirrhotic patients without this diagnosis...
May 2015: Annals of Hepatology
Sith Siramolpiwat
Portal hypertension (PH) plays an important role in the natural history of cirrhosis, and is associated with several clinical consequences. The introduction of transjugular intrahepatic portosystemic shunts (TIPS) in the 1980s has been regarded as a major technical advance in the management of the PH-related complications. At present, polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents. TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment...
December 7, 2014: World Journal of Gastroenterology: WJG
Sunil Taneja, Manavwadhawan, Subash Gupta, Neeravgoyal, Karisangal Vasudev Ramaswamy, Abhideep Chaudhary
No abstract text is available yet for this article.
April 2014: Tropical Gastroenterology: Official Journal of the Digestive Diseases Foundation
Yashwant Patidar, Sachin Kumar
Pulmonary gas exchange abnormalities and refractory hypoxemia cause myriad difficulties in patients with chronic liver disease. In addition to intrinsic cardiopulmonary diseases and hepatopulmonary syndrome, some unusual pathophysiological mechanisms in patients with portosystemic collaterals might contribute to hypoxemia. We report the clinical presentation of an unusual portosystemic anatomic shunt that permits venous admixture with oxygenated blood, causing hypoxemia that is refractory to the administration of supplemental oxygen, and recurrent hepatic encephalopathy...
March 2015: Respiratory Care
Anna Licata, Alessandra Mazzola, Daniela Ingrassia, Vincenza Calvaruso, Calogero Cammà, Antonio Craxì
The hyperdynamic syndrome is a late consequence of portal hypertension in cirrhosis. The principal hemodynamic manifestations of the hyperdynamic syndrome are high cardiac output, and increased heart rate and total blood volume, accompanied by reduced total systemic vascular resistance. Pathophysiology involves a complex of humoral and neural mechanisms that can determine hemodynamic changes, and lead to hyperdynamic circulation. In this review we focus our attention on the manifestations of the hyperdynamic syndrome...
November 2014: European Journal of Internal Medicine
Jens Schreiber, Susann Langwieler, Sandra Riedel, Kerstin Stein, Peter Malfertheiner
Interferon alpha (IFN α)-based treatment of chronic hepatitis C viral (HCV) infection may induce pulmonary and extrapulmonary sarcoidosis. We report a case of a 50-year-old male patient who suffered from hepatitis C-induced liver cirrhosis with respiratory insufficiency due to severe hepatopulmonary syndrome. After 9 months of treatment with IFNα and ribavirin, he developed an asymptomatic, clinically occult pulmonary granulomatosis, which was not detectable in CT. The diagnosis was made by bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy...
November 2014: International Journal of Clinical Pharmacology and Therapeutics
Lucas Souto Nacif, Wellington Andraus, Rafael Soares Pinheiro, Liliana Ducatti, Luciana B P Haddad, Luiz Carneiro D'Albuquerque
INTRODUCTION: The hepatopulmonary syndrome has been acknowledged as an important vascular complication in lungs developing systemic hypoxemia in patients with cirrhosis and portal hypertension. Is formed by arterial oxygenation abnormalities induced from intrapulmonary vascular dilatations with liver disease. It is present in 4-32% of patients with cirrhosis. It increases mortality in the setting of cirrhosis and may influence the frequency and severity. Initially the hypoxemia responds to low-flow supplemental oxygen, but over time, the need for oxygen supplementation is necessary...
April 2014: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
Manouchehr Khoshbaten, Mohammad Rostami Nejad, Khalil Ansarin, Reza Fatemi, David Al Dulaimi, Faramarz Derakhshan, Nagmeh Jafarinia, Sophie Barford, Mohammad Reza Zali
AIM: This study evaluated the association between serum endothelin- 1 level and symptoms, clinical examination, laboratory and cardio-respiratory parameters, in patients with cirrhosis compared to controls. BACKGROUND: Cirrhosis is associated with significant portal, pulmonary and systemic vascular abnormities. Recent studies have suggested that endothelin -1 may have a significant role in the regulation of vascular tone. PATIENTS AND METHODS: In this case - control study, subjects that had been evaluated and diagnosed with biopsy-proven cirrhosis and age-matched controls with no evidence of cardio-vascular or liver disease were recruited...
2012: Gastroenterology and Hepatology From Bed to Bench
Salman Nusrat, Muhammad S Khan, Javid Fazili, Mohammad F Madhoun
Cirrhosis results from progressive fibrosis and is the final outcome of all chronic liver disease. It is among the ten leading causes of death in United States. Cirrhosis can result in portal hypertension and/or hepatic dysfunction. Both of these either alone or in combination can lead to many complications, including ascites, varices, hepatic encephalopathy, hepatocellular carcinoma, hepatopulmonary syndrome, and coagulation disorders. Cirrhosis and its complications not only impair quality of life but also decrease survival...
May 14, 2014: World Journal of Gastroenterology: WJG
Rabea Alhosh, Yuri Genyk, Sophoclis Alexopoulos, Daniel Thomas, Shengmei Zhou, George Yanni, Nanda Kerkar
HPS is a significant complication of portal hypertension in children with chronic liver disease and is an established indication for LT. It is characterized clinically by the triad of pulmonary vascular dilatation causing hypoxemia in the setting of advanced liver disease. NRH, a cause of non-cirrhotic portal hypertension, is characterized by diffuse benign transformation of the hepatic parenchyma into small regenerative nodules with minimal or no fibrosis. Development of NRH and HPS in pediatric LT recipients has not been reported, although occasional cases have been reported in adult LT recipients...
August 2014: Pediatric Transplantation
Thomas Horvatits, Andreas Drolz, Kevin Roedl, Harald Herkner, Arnulf Ferlitsch, Thomas Perkmann, Christian Müller, Michael Trauner, Peter Schenk, Valentin Fuhrmann
BACKGROUND & AIMS: Hepatopulmonary syndrome (HPS) occurs in 20-30% of patients with liver cirrhosis and is associated with a >2 fold increased mortality. Endothelial dysfunction seems to play a central role in its pathogenesis. von Willebrand factor antigen (vWF-Ag), an established marker of endothelial dysfunction, is significantly elevated in patients with liver cirrhosis, portal hypertension, and in experimental HPS. Aim of the present study was to evaluate the impact of vWF-Ag as a screening marker for presence of HPS in patients with stable cirrhosis...
September 2014: Journal of Hepatology
T Horvatits, A Drolz, K Rutter, S Kluge, V Fuhrmann
Pulmonary-hepatic vascular disorders are frequent complications in patients with portal hypertension and cirrhosis. Hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), and hepatic hydrothorax are relevant disease entities in these patients. HPS occurs in up to 30 % of patients with cirrhosis and is associated with a more than 2-fold increased mortality. The diagnosis of HPS should be established early by arterial blood gas analysis and contrast-enhanced echocardiography, whereas POPH is diagnosed by the presence of pulmonary arterial hypertension evaluated via right heart catheterization and the presence of portal hypertension...
May 2014: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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