Síndrome hepatopulmonar en pacientes cirróticos descompensados / Hepatopulmonary syndrome in decompensed cirrhotic patients

ABSTRACT

Hypoxemia is common in cirrhotic patients and when obvious pulmonary or cardiac causes are discarded, it is attributed to the so-called hepatopulmonary syndrome. The aim of this work was to assess the frequency of hypoxemia and orthodeoxia ans its relationship with the degree of liver failure, in cirrhotic alcoholic patients. We studied 30 alcoholic cirrhotics. In all, arterial blood gases were measured in supine and standing positions in 26 a chest X ray examination was done and in 20 a spirometry. Twelve patients had a subnormal PaO2 and this parameter fell more than 10 percent when assuming the standing position in one of these. The same reduction was observed in 2 subjects with normal supine PaO2. In the chest X ray examinations, pleural effusions were observed in five hypoxemic subjects and 4 with normal PaO2. Likewise minimal athelectasis was found in 6 and 7 subjects and interstitial infiltrates in one and two subjects. A significant association between hypoxemia and Pugh score was observed. Similarly, subjects with hypoxemia had a higher frequency of large esophageal varices. It is concluded that hypoxemia is frequent in alcoholic cirrhotic patients and since it is associated to obvious pulmonary causes, it may be attributed to the hepatopulmonary syndrome