الفهرس 
Cirrhosis and HepatopulmonaryOnly 14 pages are availabe for public view
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Abstract
irrhosis is a chronic (on going, long term) disease of the liver. It means damage to the normal liver tissue that prevents this important organ from working as it should. If the damage is not stopped, the liver gradually loses its ability to carry out its normal functions. This is called liver failure, sometimes referred to as end stage liver disease.Cirrhosis of the liver is disease found all over the world, affecting all races, age groups and both sexes. The clinical presentation of liver cirrhosis is often asymptomatic until complications appear.
The lung and liver are closely interrelated with disease processes in one affecting the function of the other. Liver cirrhosis is associated with a wide range of pulmonary and vascular abnormalities including hyperdynamic circulation and intrapulmonary vascular changes.The pathogenic mechanisms of these changes are multifactorial and include neurohumoral and vascular dysregulations.
These changes play the major role in the pathogenesis of multiple life-threatening complications including hepatopulmonary syndrome, ascites, spontaneous bacterial peritonitis, gasteroesophageal varices and hepatorenal syndrome.
Intrapulmonary vascular dilatation that causes profound hypoxemia may develop in patients with severe liver disease.
In a minority of these patients, this hypoxemia may indicate the development of HPS.
This hypoxemia is temporarily correctable with supplemental oxygen, but HPS is only reversible with the elimination of the underlying liver disease. Liver transplantation being increasingly recognized as the only option available to treat HPS and dramatically improve hypoxemia in select patients.
Because HPS is still under recognized complication of end stage liver disease, health care providers must consider its development in every patient with advanced liver disease manifesting symptoms of dyspnea and hypoxemia.
The present study was done in order to detect the accuracy of pulse oximetry in the detection of arterial hypoxemia and pulmonary dysfunction in chronic liver disease.
It was performed on 60 patients with chronic liver disease and cirrhosis.All patients were subjected to detailed medical history taking with special emphasis on chest symptoms, gastrointestinal symptoms and history of any other chest or cardiovascular disease. General and local examination, were performed for all patients as well as laboratory investigations including: LFT, KFT, CBC, PH, INR, PT, Na, K, ABG, O2 saturation by pulse oximetry in both supine and upright position.
Imaging investigations as:
Abdominal ultrasound, ECG, and chest x-ray were also done. 8 patients were females (13.3%) and 52 patients were males (86.7%) their age ranged between 45-76 years with a mean age (56.2_+5.9).ECG and chest x-ray were all normal.
22 of them (36.7%) are platypnic and 38 (63.3%) are non platypnic.By ABG and pulse oximetry in supine position there was no significant changes in o2 saturation in all cases platypnic and non platypnic.But in upright position o2 saturation by pulse oximetry was significantly lower than supine position especially in platypnic cases that is called orthodeoxia when the change in o2 saturation from supine to upright position more than 4%.
According to demographic characteristics platypnic cases occurred more in old age patients. No significant difference platypnic and non platypnic cases as regard to sex.
Liver function were significantly higher in platypnic than non platypnic cases also higher grades of Child Pugh were more frequent in platypnic cases.Also platypnic cases had higher PH and lower pco2.
So our study showed good results that the pulse oximetry is a useful tool, simple and rapid method for
screening of hypoxemia, also used in follow up of hypoxemia in patients of chronic liver disease and cirrhosis and help in early diagnosis of HPS. So we recommend frequent ABG or pulse oximetry examination (better because it is noninvasive and easy) for patients with liver cirrhosis with special emphasis on po2 and o2 saturation as a predictor for disease worsening and liability for pulmonary complication in setting of cirrhosis.
This will guide the future management by speeding up to liver transplantation on recommendations.