Hepatopulmonary VS Portopulmonary .....

Hepatopulmonary syndrome:
Due to vascular dilation at the pre- and post-capillary level therefore decreased VQ ratio

Intrapulmonary vasodilation with R to left shunting mainly affecting the basal area,so it worsen with sitting up due to increas basal blood flow

Diagnostic criteria:
Chronic liver disease +\- chirosis

Arterial hypoxaemia
PaO2 < 75 or Aa gradient > 20 Intrapulmonary vascular dilation
Diagnose with contrast echo. Agitated saline injected IV. Immediate visualisation in L heart intracardiac shunt. Delayed visualisation means intrapleural shunt
Medical management disappointing
It s indication for transplant with resolution usual in the months afterwards. However, the more hypoxic the greater the perioperative risk

Porto-pulmonary hypertension:
Diagnostic criteria:
Portal hypertension
Mean pulmonary artery pressure > 25
Pulmonary artery occlusion pressure < 15
Pulmonary vascular resistance > 120 dynes/s/cm5
Usually due to increased pulmonary flow, not increased resistance – these patients do well
In < 4%, pulmonary hypertension is due to increased pulmonary vascular resistance 2nd to pulmonary vasoconstriction. More serious. Trials of post-transplant treatment with epoprostenol (a PGI2 analogue) encouraging

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power injectable peripherally inserted central catheters

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