Hepatopulmonary syndrome history and symptoms
|
Hepatopulmonary syndrome Microchapters |
|
Differentiating Hepatopulmonary syndrome from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Hepatopulmonary syndrome history and symptoms On the Web |
|
American Roentgen Ray Society Images of Hepatopulmonary syndrome history and symptoms |
|
Risk calculators and risk factors for Hepatopulmonary syndrome history and symptoms |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
The hallmark of hepatopulmonary syndrome is platypnea and orthodeoxia. A positive history of liver disease and dyspnea is suggestive of hepatopulmonary syndrome. Other sign and symptoms of hepatopulmonary syndrome may include spider angiomata, clubbing of fingers or toes, and cyanosis.
History and Symptoms
- The majority of patients with hepatopulmonary syndrome (80 percent) initially present with their liver disease symptoms. The remaining 20 percent present with pulmonary symptoms. The most complication and presentation is insidiously progressive shortness of breath (dyspnea) at rest or upon exertion.[1]
- The hallmark of hepatopulmonary syndrome is platypnea (dyspnea in the upright position which is improved in supine position), and orthodeoxia (a drop of 4mmHg in PaO2 or 5% in saturation when moving from the supine to the standing position). Almost 90 percent of patients with HPS present with this specific finding. [2]
- Other sign and symptoms of hepatopulmonary syndrome may include spider angiomata, clubbing of fingers or toes, and cyanosis.
History
Patients with hepatopulmonary syndrome may have a positive history of:
- liver disease
- Either severe or mild disease could be complicated with HPS.
- Although most of the patients with HPS suffer from chronic liver disease, it might happen in a patient with acute liver disease as well.
- History of infections:
- Hepatitis B
- Hepatitis C
- History of autoimmune disorders:
- History of blood transfusions
- History of infections:
- Dyspnea
- Unexplained decreased O2 Saturation below 96 percent.
- Platypnea
- Orthodeoxia
Common Symptoms
Common symptoms of hepatopulmonary syndrome include:
- Dyspnea
- Platypnea
- Clubbing
- Cyanosis
- Symptoms of liver disease like:
- Spider nevi
- Symptoms of hypogonadism:
- Impotence
- Infertility
- Testicular atrophy
- Loss of libido
- Easy bruisability
- Decompensated cirrhosis presentations such as:
- Jaundice
- Increase in abdominal girth due to ascites
- Pruritus
- Signs of upper gastrointestinal bleeding:
- Symptoms due to hepatic encephalopathy:
- Altered mental status
- Confusion
- Sleep disturbances
- Muscle cramps due to reduction in effective circulating plasma volume
- Lower extremity edema
- Symptoms of hypogonadism:
Less Common Symptoms
Less common symptoms of hepatopulmonary syndrome include
- Clubbing
- Cyanosis
References
- ↑ Lima BL, França AV, Pazin-Filho A, Araújo WM, Martinez JA, Maciel BC et al. (2004) Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome. Mayo Clin Proc 79 (1):42-8. DOI:10.4065/79.1.42 PMID: 14708947
- ↑ Rodríguez-Roisin R, Krowka MJ (2008) Hepatopulmonary syndrome--a liver-induced lung vascular disorder. N Engl J Med 358 (22):2378-87. DOI:10.1056/NEJMra0707185 PMID: 18509123
- ↑ Fallon MB, Abrams GA (2000) Pulmonary dysfunction in chronic liver disease. Hepatology 32 (4 Pt 1):859-65. DOI:10.1053/jhep.2000.7519 PMID: 11003635
- ↑ Krowka MJ, Mandell MS, Ramsay MA, Kawut SM, Fallon MB, Manzarbeitia C et al. (2004) Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database. Liver Transpl 10 (2):174-82. DOI:10.1002/lt.20016 PMID: 14762853
- ↑ Kennedy TC, Knudson RJ (1977) Exercise-aggravated hypoxemia and orthodeoxia in cirrhosis. Chest 72 (3):305-9. DOI:10.1378/chest.72.3.305 PMID: 891282
- ↑ Krowka MJ, Fallon MB, Kawut SM, Fuhrmann V, Heimbach JK, Ramsay MA et al. (2016) International Liver Transplant Society Practice Guidelines: Diagnosis and Management of Hepatopulmonary Syndrome and Portopulmonary Hypertension. Transplantation 100 (7):1440-52. DOI:10.1097/TP.0000000000001229 PMID: 27326810
- ↑ Krowka MJ, Dickson ER, Cortese DA (1993) Hepatopulmonary syndrome. Clinical observations and lack of therapeutic response to somatostatin analogue. Chest 104 (2):515-21. DOI:10.1378/chest.104.2.515 PMID: 8101797
- ↑ Swanson KL, Wiesner RH, Krowka MJ (2005) Natural history of hepatopulmonary syndrome: Impact of liver transplantation. Hepatology 41 (5):1122-9. DOI:10.1002/hep.20658 PMID: 15828054
- ↑ Rodríguez-Roisin R, Agustí AG, Roca J (1992) The hepatopulmonary syndrome: new name, old complexities. Thorax 47 (11):897-902. DOI:10.1136/thx.47.11.897 PMID: 1465744