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Research ArticleSpecial Articles

Respiratory Dysfunction and Pulmonary Disease in Cirrhosis and Other Hepatic Disorders

Julie L Huffmyer and Edward C Nemergut
Respiratory Care August 2007, 52 (8) 1030-1036;
Julie L Huffmyer
Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia.
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Edward C Nemergut
Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia.
Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.
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Abstract

End-stage liver disease and its complications are a leading cause of death among adults in the United States, and thousands of patients await liver transplantation. 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. We review the general effects of cirrhosis on the respiratory system, including mild hypoxemia, atelectasis, and hepatic hydrothorax. Cirrhosis is associated with 2 unique entities that affect the pulmonary vasculature: hepatopulmonary syndrome and portopulmonary hypertension. Hepatopulmonary syndrome, which is found in approximately 20% of patients awaiting liver transplantation, refers to the triad of hepatic dysfunction, hypoxemia, and intrapulmonary vascular dilations, and responds well to liver transplantation. In portopulmonary hypertension, cirrhosis and portal hypertension lead to pulmonary arterial hypertension, and portopulmonary hypertension has been considered a contraindication for transplantation. Currently, patients must have mild to moderate pulmonary hypertension to be considered for transplantation, and may still require long-term therapy with vasodilators to prevent right-ventricular failure and, consequently, failure of the newly transplanted liver allograft.

  • liver disease
  • cirrhosis
  • hepatic hydrothorax
  • hepatopulmonary syndrome
  • portopulmonary hypertension

Footnotes

  • Correspondence: Edward C Nemergut MD, Department of Anesthesiology, University of Virginia Health System, PO Box 800710, Charlottesville VA 22908. E-mail: en3x{at}virginia.edu.
  • The authors report no conflicts of interest related to the content of this paper.

  • Copyright © 2007 by Daedalus Enterprises Inc.
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Respiratory Care: 52 (8)
Respiratory Care
Vol. 52, Issue 8
1 Aug 2007
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Respiratory Dysfunction and Pulmonary Disease in Cirrhosis and Other Hepatic Disorders
Julie L Huffmyer, Edward C Nemergut
Respiratory Care Aug 2007, 52 (8) 1030-1036;

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Respiratory Dysfunction and Pulmonary Disease in Cirrhosis and Other Hepatic Disorders
Julie L Huffmyer, Edward C Nemergut
Respiratory Care Aug 2007, 52 (8) 1030-1036;
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Keywords

  • liver disease
  • cirrhosis
  • hepatic hydrothorax
  • hepatopulmonary syndrome
  • portopulmonary hypertension

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