Hepatopulmonary syndrome other diagnostic studies: Difference between revisions
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{{CMG}}; {{AE}} {{Soroush}} | {{CMG}}; {{AE}} {{Soroush}} | ||
==Overview== | ==Overview== | ||
'''Pulmonary function tests''' may be helpful in the diagnosis of hepatopulmonary syndrome. Findings suggestive of hepatopulmonary syndrome include A decrease in the single-breath [[DLCO|diffusing capacity for carbon monoxide (DLCO)]] suggesting a diffusion impairment as | '''Pulmonary function tests''' may be helpful in the diagnosis of hepatopulmonary syndrome. Findings suggestive of hepatopulmonary syndrome include A decrease in the single-breath [[DLCO|diffusing capacity for carbon monoxide (DLCO)]] suggesting a diffusion impairment as a frequent finding in hepatopulmonary syndrome (occurring in up to 80% of patients). '''Six minute walk test with and without an oxygen titration''' can also use as an objective assessment of exercise capacity. | ||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
'''Pulmonary Function Tests''' | '''Pulmonary Function Tests''' | ||
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*A decrease in the single-breath diffusing capacity for carbon monoxide (DLCO) (not specific) is the most prevalent finding. | *A decrease in the single-breath diffusing capacity for carbon monoxide (DLCO) (not specific) is the most prevalent finding. | ||
*A mean [[DLCO]] of 55% predicted in HPS patients compared to a mean of 72% predicted in people with cirrhosis who do not have HPS . | *A mean [[DLCO]] of 55% predicted in HPS patients compared to a mean of 72% predicted in people with cirrhosis who do not have HPS . | ||
*Reduced lung volumes might barely observed in tense ascites or in the presence of [[pleural effusion]]<nowiki/>s due to [[oncotic pressure]] disturbance or other reasons. (neither [[Specificity (tests)|specific]] nor [[Sensitivity (tests)|sensitive]]) | *Reduced lung volumes might barely be observed in tense ascites or in the presence of [[pleural effusion]]<nowiki/>s due to [[oncotic pressure]] disturbance or other reasons. (neither [[Specificity (tests)|specific]] nor [[Sensitivity (tests)|sensitive]]) | ||
'''Six Minute Walk Test With and Without an Oxygen Titration''' | '''Six Minute Walk Test With and Without an Oxygen Titration''' | ||
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* A decrease below 88% O2 saturation with exertion calls for an oxygen titration study to identify and match oxygen requirements. | * A decrease below 88% O2 saturation with exertion calls for an oxygen titration study to identify and match oxygen requirements. | ||
<ref name="pmid18509123">Rodríguez-Roisin R, Krowka MJ (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18509123 Hepatopulmonary syndrome--a liver-induced lung vascular disorder.] ''N Engl J Med'' 358 (22):2378-87. [http://dx.doi.org/10.1056/NEJMra0707185 DOI:10.1056/NEJMra0707185] PMID: [https://pubmed.gov/18509123 18509123]</ref> | |||
<ref name="pmid11003635">Fallon MB, Abrams GA (2000) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11003635 Pulmonary dysfunction in chronic liver disease.] ''Hepatology'' 32 (4 Pt 1):859-65. [http://dx.doi.org/10.1053/jhep.2000.7519 DOI:10.1053/jhep.2000.7519] PMID: [https://pubmed.gov/11003635 11003635]</ref> | |||
<ref name="pmid14762853">Krowka MJ, Mandell MS, Ramsay MA, Kawut SM, Fallon MB, Manzarbeitia C et al. (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14762853 Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database.] ''Liver Transpl'' 10 (2):174-82. [http://dx.doi.org/10.1002/lt.20016 DOI:10.1002/lt.20016] PMID: [https://pubmed.gov/14762853 14762853]</ref> | |||
<ref name="pmid891282">Kennedy TC, Knudson RJ (1977) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=891282 Exercise-aggravated hypoxemia and orthodeoxia in cirrhosis.] ''Chest'' 72 (3):305-9. [http://dx.doi.org/10.1378/chest.72.3.305 DOI:10.1378/chest.72.3.305] PMID: [https://pubmed.gov/891282 891282]</ref> | |||
<ref name="pmid27326810">Krowka MJ, Fallon MB, Kawut SM, Fuhrmann V, Heimbach JK, Ramsay MA et al. (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=27326810 International Liver Transplant Society Practice Guidelines: Diagnosis and Management of Hepatopulmonary Syndrome and Portopulmonary Hypertension.] ''Transplantation'' 100 (7):1440-52. [http://dx.doi.org/10.1097/TP.0000000000001229 DOI:10.1097/TP.0000000000001229] PMID: [https://pubmed.gov/27326810 27326810]</ref> | |||
==References== | ==References== | ||
Revision as of 14:53, 5 September 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
Pulmonary function tests may be helpful in the diagnosis of hepatopulmonary syndrome. Findings suggestive of hepatopulmonary syndrome include A decrease in the single-breath diffusing capacity for carbon monoxide (DLCO) suggesting a diffusion impairment as a frequent finding in hepatopulmonary syndrome (occurring in up to 80% of patients). Six minute walk test with and without an oxygen titration can also use as an objective assessment of exercise capacity.
Other Diagnostic Studies
Pulmonary Function Tests
- Usually PFT in HPS patients usually reveal normal flows and lung volumes,
- Pulmonary function testing (PFT) may be helpful in the diagnosis of hepatopulmonary syndrome.
- Findings suggestive of hepatopulmonary syndrome include:
- Diffusion impairment is a frequent finding in HPS, occurring in up to 80% of patients.
- Nevertheless this finding is frequent in people with cirrhosis who do not have HPS as well, (50-70% of cirrhotic patients)
- A decrease in the single-breath diffusing capacity for carbon monoxide (DLCO) (not specific) is the most prevalent finding.
- A mean DLCO of 55% predicted in HPS patients compared to a mean of 72% predicted in people with cirrhosis who do not have HPS .
- Reduced lung volumes might barely be observed in tense ascites or in the presence of pleural effusions due to oncotic pressure disturbance or other reasons. (neither specific nor sensitive)
Six Minute Walk Test With and Without an Oxygen Titration
- Objective assessment of exercise capacity
- A decrease below 88% O2 saturation with exertion calls for an oxygen titration study to identify and match oxygen requirements.
References
- ↑ 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