Study of pulmonary dysfunctions in liver cirrhosis

Abstract

IntroductionEnd-stage liver disease and its complications are a leading cause of death among adults. The liver plays a central role in health and homeostasis and thus the diseased liver leads to many deleterious effects on multiple organ systems, including the pulmonary system Julie et al. (2007) [1]. A variety of causes for pulmonary dysfunction in liver disease have been identified and include intrinsic cardiopulmonary disorders not specifically related to liver disease as well as unique problems associated with the presence of liver disease and/or portal hypertension Michael et al. (2000) [2]. Liver disease and portal hypertension can be associated with pulmonary vascular complications, including portopulmonary hypertension (POPH), and hepatopulmonary syndrome (HPS) Mateo et al. (2012) [3]. AimThis study aimed to evaluate the pulmonary dysfunctions complicating liver cirrhosis. Patients and methodsFifty patients with liver cirrhosis without intrinsic cardiopulmonary disease were enrolled in this study. All were subjected to complete clinical examination, laboratory investigations, radiological investigations including abdominal ultrasound, chest x ray and CT chest, ECG, contrast enhanced echocardiography with colored Doppler study, gastroscopy, ventilatory function tests, measurement of SaO2 using portable pulse oximetry and arterial blood gas analysis. ResultsThe prevalence of arterial hypoxemia in cirrhotic patients was 14.6%. The presence of hypoxemia is increased in patients with advanced liver disease and the severity of hypoxemia was positively correlated with the severity of liver disease assessed by the Child Pugh score. HPS represents 64.1% of causes of hypoxemia. Pulse oximetry is a simple non-invasive method for detection of arterial hypoxemia as an initial screening test for HPS. Contrast enhanced echocardiography (CEE) is the gold standard method for the diagnosis of HPS by detection of intrapulmonary vasodilatation (IPV) characteristic of HPS, while CT chest assists in diagnosis by exclusion of intrinsic pulmonary disease. ConclusionLiver cirrhosis is associated with unique pulmonary complications. The early identification of pulmonary dysfunctions in cirrhotic patients is crucial as it affects the prognosis and guides the future management by speeding up orthotopic liver transplantation (OLT) recommendations.