Prevalence of hepatopulmonary syndrome in patients with cirrhosis of liver.

Syed Ansari, J (2015) Prevalence of hepatopulmonary syndrome in patients with cirrhosis of liver. Masters thesis, Madras Medical College, Chennai.


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Cirrhosis of liver is a very common disease which clinicians encounter both at primary and tertiary care. Development of pulmonary manifestations in cirrhosis has several clinical implications with regard to their management, since they carry a poor prognosis. These include pleural effusion, restrictive and obstructive lung disease, Hepatopulmonary syndrome and portopulmonary syndrome. Hepatopulmonary Syndrome (HPS) is a triad of liver disease, hypoxemia and intrapulmonary vascular dilatation. The reported prevalence of HPS in cirrhotic patients varies between 4% and 19%. AIMS & OBJECTIVES: To study the pulmonary profile in patients with cirrhosis with reference to arterial hypoxemia. To detect the presence of hepatopulmonary syndrome among cirrhotic patients. MATERIAL & METHODS: Patients admitted in Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai with cirrhosis of liver, proven by clinical, sonographic and endoscopy evidence, fulfilling the inclusion and exclusion criteria were included in the study. Data was collected in a pretested proforma meeting the objectives of the study. 40 cases were selected on the basis of the simple random sampling technique. Emphasis was placed on the pulmonary complaints and its impact. Patients were investigated for Arterial blood gas analysis, Spirometry and Contrast Echocardiogram. Relevant Statistical methods were applied. RESULTS: In our study, Cirrhosis was common in young adults in the fourth decade with male to female ratio of 3:1. The most common respiratory system finding was right pleural effusion and it was the most common chest radiographic abnormality. Restriction was the most common abnormality in pulmonary function tests. Hypoxemia was present in 17.5% of cirrhotics, out of which 4 patients (10%) were found to have Hepatopulmonary Syndrome (HPS). Orthodeoxia was the characteristic feature of the patients who had HPS. All 4 patients with HPS presented with cyanosis, orthodeoxia and spider naevi. Spider naevi could be a marker for the presence of intrapulmonary vascular dilatation. CONCLUSION The feature of our study was the detection of hypoxemia in patients with cirrhosis of liver. Degree of hypoxemia worsens with higher grade of varices. Severity of liver disease also worsens hypoxemia. Hepato pulmonary syndrome was seen in 10% of patients with cirrhosis. The prevalence of HPS is influenced by the severity of liver disease. The only proven treatment for HPS is liver transplantation. As prognosis of HPS is poor, screening for its presence in cirrhotic patients is very important.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Hepatopulmonary Syndrome; Hypoxemia; Orthodeoxia; Contrast Echocardiogram; Arterial Blood Gas Analysis
Subjects: MEDICAL > General Medicine
Depositing User: Punitha K
Date Deposited: 03 Jan 2018 07:39
Last Modified: 03 Jan 2018 07:39

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