الفهرس 
Liver CirrhosisOnly 14 pages are availabe for public view
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Abstract
HPS is a unique pulmonary vascular complication of liver disease and/or portal hypertension that may cause significant morbidity and influence survival and liver transplantation candidacy (56).
The pathogenesis of HPS is well delineated, the syndrome occurs as a result of precapillary and/or capillary pulmonary vascular dilatations, causing apparent right-to-left intrapulmonary shunting, though there is no true anatomic shunt, however, the capillaries may become dilated to 500 µm in diameter (normal range 8-15 µm) (48).
Hypoxemia arises due to a combination of ventilation and perfusion mismatching, oxygen diffusing limitation and intrapulmonary shunting (102).
These intrapulmonary vascular abnormalities in advanced liver cirrhosis are attributed to an excess production of vasodilators that affect the lung vascular system via porto-systemic shunt, with nitric oxide as the most likely mediator; this is in accordance with the complete reversion of the syndrome when liver transplantation is successful in patients with end-stage liver disease and HPS (110).
This study was conducted to assess various diagnostic methods for detecting intrapulmonary vascular dilatations in Hepatopulmonary syndrome and their correlation with the stages of liver cirrhosis.
The study population composed of thirty adult patients with chronic liver disease and were divided into two groups:
• HPS Group: patients with HPS and chronic liver disease
• Non-HPS Group: patients without HPS but have chronic liver disease.
The two groups had been subjected to the following:
11. Full medical history and clinical examination.
12. Liver function tests
13. Lung spirometry
14. Complete blood count.
15. Abdominal ultrasonography.
16. Arterial blood gas analysis and calculation of alveolar-arterial oxygen gradient.
17. Saline two-dimensional contrast enhanced echocardiography.
18. Technetium99m-Macroaggregated Albumin perfusion lung and total body scan.
19. Roentgenographic examination of the chest including plain chest radiography and thoracic high resolution computed tomography
The results obtained from this study revealed that the duration of chronic liver disease was significantly lower in HPS patients than in NON-HPS patients, dyspnoea was a highly significant sign for the diagnosis of HPS while clubbing and spider nevi were significant associative signs in HPS.
Hypoxemia and/or elevated oxygen gradient were highly significant more in patients with HPS than those without HPS. Since hypoxemia and elevated PA-aO2 are not pathognomic for HPS, contrast enhanced echocardiography (CEE) is necessary to discriminate between intrapulmonary or intracardiac right-to-left shunts. Contrast material–enhanced echocardiography is considered to be the standard in the diagnosis of HPS. This study demonstrated that 33% of the patients hospitalized for decompensated CLD had IPVD and HPS. Most of the patients had mild to moderate HPS, so there was a highly significant difference between CEE of the two groups.
While technetium99m labeled macroaggregated albumin total body scan specifically showed a highly significant difference between HPS patients and non-HPS patients.
Also chest x-ray and thoracic HRCT showed highly significant difference between HPS patients and non-HPS patients.
The study revealed a highly significant correlation between Child’s-Turcotte-Pugh score and MELD score and the presence of HPS among the studied cirrhotic patients.