medigraphic.com
ISSN 2594-1526 (Electronic)
Antes Revista del Instituto Nacional de Enfermedades Respiratorias

 Ver anteriores al 2010

2016, Number 1

<< Back Next >>

Neumol Cir Torax 2016; 75 (1)

Hepatopulmonary syndrome: Clinical situation in a third level hospital in Puebla, México

Salazar-Marcelino AE, Herrera-García JC, Toledo-Estrada J, Mendoza-Torres MÁ, Romero-Ogawa T

Language: Spanish
References: 26
Page: 18-24
PDF size: 194.83 Kb.


ABSTRACT

Introduction: The hepatopulmonary syndrome (HPS) is one of the less frequent extrahepatic manifestations of liver failure. It has an incidence of 13 to 47%, with a survival of 40% at 2.5 years. Objective: Describe the diagnosis and clinical course of HPS in Mexican patients. Material and methods: Descriptive, observational, longitudinal study and ambilective. We studied 94 patients with clinical liver established as diagnostic criteria for HPS: suggestive clinical data as cough not associated with infectious processes, chest pain, dyspnea, orthodeoxia and/or platypnea, alveolar/arterial gradient of oxygen higher than 15 mmHg, intrapulmonary vasodilation evaluated by contrast echocardiography and pulmonary function tests by the Department of Pneumology Specialist Hospital May 5, ISSSTEP, Puebla, in the period from March 2014 to August 2014. Results: The presence of HPS in 4 patients (4.2%) was determined, the most prevalent etiology was associated by non-alcoholic liver disease in 35.1%, associated with alcohol in 24.4%, 15.9% viral and other 24.5%. The most common symptoms associated with HPS were dyspnea, chest pain and chronic cough. 100% of patients (4 patients) had varying degrees hypoxemia. The severity of the disease not listed by Child Pugh determines the appearance of symptoms. Conclusion: HPS occurs in 4.2% of patients, they have hypoxemia and elevation of the alveolar-arterial gradient. The severity of liver disease does not determine the development of the disease. Its early detection reduces mortality of patients.


REFERENCES

  1. Hemprich U, Papadakos PJ, Lachmann B. Respiratory failure and hypoxemia in the cirrhotic patient including hepatopulmonary syndrome. Curr Opin Anaesthesiol 2010;23(2):133-138. doi: 10.1097/ACO.0b013e328335f024.

  2. Martínez LE, Jiménez ZVH, Gallardo ALA, Álvarez MI. Síndrome hepatopulmonar. An Med (Mex) 2006;51(3):124-133.

  3. Zagolín BM, Medel FJN, Valera MJ. Síndrome hepatopulmonar e hipertensión portopulmonar: Dos entidades a diferenciar. Rev Chil Enf Respir 2008;24(4): 291-303.

  4. Shijo H, Sasaki H, Sakata H, Kusuhara H, Ueki T, Okumura M. Reversibility of hepatopulmonary syndrome evidenced by serial pulmonary perfusion scan. Gastroenterol Jpn 1993;28(1):126-131.

  5. Douglas LaBrecque World Gastroenterology Organization Global Guidelines World, Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis; 2012. Access date: January 22, 2016. Available from: http://www.worldgastroenterology.org/guidelines/global-guidelines/nafld nash/nafld-nash-english

  6. García BL, González MF, Moreno-Otero R. Cirrosis hepática. Medicine 2012;11(11):625-633.

  7. Swanson KL, Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: Impact of liver transplantation. Hepatology 2005;41(5):1122-1129.

  8. Zhang ZJ, Yang CQ. Progress in investigating the pathogenesis of hepatopulmonary syndrome. Hepatobiliary Pancreat Dis Int 2010;9(4):355-360.

  9. Carrillo ER, González SJA, Serralde ZA. Síndrome hepatopulmonar. Rev Fac Med UNAM 2001;44(5). Fecha de acceso: 22 de enero, 2016. Accesible en: http://www.ejournal.unam.mx/rfm/no44-5/RFM44505.pdf

  10. Rodríguez-Roisin R, Krowka MJ. Hepatopulmonary syndrome-a liver-induced lung vascular disorder. N Engl J Med 2008;358(22):2378-2387. doi: 10.1056/NEJMra0707185.

  11. Monsel A, Mal H, Brisson H, et. al. Extracorporeal membrane oxygenation as a bridge to liver transplantation for acute respiratory distress syndrome induced life threatening hypoxaemia aggravated by hepatopulmonary syndrome. Crit Care 2011;15(5):R234. doi: 10.1186/cc10476.

  12. Shijo H, Nakayama K, Sasaki H, et al. Reversibility of pulmonary telangiectasia in liver cirrhosis evidenced by serial dynamic pulmonary perfusion imaging. Clin Nucl Med 1989;14(12):909-911.

  13. Herve P, Le Pavec J, Sztrymf B, Decante B, Savale L, Sitbon O. Pulmonary vascular abnormalities in cirrhosis. Best Pract Res Clin Gastroenterol 2007;21(1):141-159.

  14. Schenk P, Fuhrmann V, Madl C, et al. Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 2002; 51(6):853-859. Access date: January 22, 2016. Available from: http://gut.bmj.com/content/51/6/853.full.pdf+html

  15. Rodríguez-Roisin R, Krowka MJ, Hervé P, Fallon MB; ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 2004;24(5):861-880.

  16. Varghese J, Ilias-basha H, Dhanasekaran R, Singh S, Venkataraman J. Hepatopulmonary syndrome-past to present. Ann Hepatol 2007;6(3):135-142.

  17. Uribe M, Morales-Blanhir J, Rosas-Romero R, Campos CR, Poo JL. Epidemiología, fisiopatología y diagnóstico de la hipertensión arterial pulmonar (HAP) en el cirrótico. Gaceta Médica de México 2012;148(2):153-161.

  18. Fallon MB, Zhang J. The lung in liver disease: old problem, new concepts. Trans Am Clin Climatol Assoc 2013;124:250-262.

  19. Fallon MB, Krowka MJ, Brown RS, et al; Pulmonary Vascular Complications of Liver Disease Study Group. Impact of hepatopulmonary syndrome on quality of life and survival in liver transplant candidates. Gastroenterology 2008;135(4):1168-1175. doi: 10.1053/j.gastro.2008.06.038.

  20. Shafiq M, Khan AA, Alam A, et al. Frequency of hepatopulmonary syndrome in cirrhotic patients. J Coll Physicians Surg Pak 2008;18(5):278-281. doi: 05.2008/JCPSP.278281.

  21. Porres-Aguilar M, Gallegos-Orozco JF, García H, Aguirre J, Macías-Rodríguez RU, Torre-Delgadillo A. Complicaciones pulmonares vasculares en hipertensión portal y enfermedad hepática: una revisión concisa. Rev Gastroenterol Méx 2013;78(1):35-44.

  22. Schenk P, Schöniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G, Müller C. Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis. Gastroenterology 2003;125(4):1042-1052.

  23. El Makarem MA, Elakad A, Ali A, et al. Hepatopulmonary syndrome: prevalence and predictors in Egyptian cirrhotic patients. Trop Gastroenterol 2011;32(1):25-30.

  24. Zhang J, Luo B, Tang L, et al. Pulmonary angiogenesis in a rat model of hepatopulmonary syndrome. Gastroenterology 2009;136(3):1070-1080. doi: 10.1053/j.gastro.2008.

  25. Muñoz CS, Bardi SA, Sapunar PJ, Antolini TM. Síndrome hepatopulmonar. Revista HCUCh 2006;17:229-237. Fecha de acceso: Enero 22, 2016. Accesible en: https://www.redclinica.cl/Portals/0/Users/014/14/14/Publicaciones/Revista/sidrome_hepatopulmar.pdf.

  26. Roberts DN, Arguedas MR, Fallon MB. Cost-effectiveness of screening for hepatopulmonary syndrome in liver transplant candidates. Liver Transpl 2007; 13(2):206-214.




2020     |     www.medigraphic.com