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==Screening==
==Screening==
*There is insufficient evidence to recommend routine screening for hepatopulmonary syndrome. Nevertheless, it should be considered as a differential diagnosis in every patient with known liver disease or sign and symptoms of liver disease that present with hypoxemia, and dyspnea.
*There is insufficient evidence to recommend routine screening for hepatopulmonary syndrome. Nevertheless, it should be considered as a differential diagnosis in every patient with known liver disease or sign and symptoms of liver disease that present with hypoxemia, and dyspnea.<ref name="pmid12427789">Schenk P, Fuhrmann V, Madl C, Funk G, Lehr S, Kandel O et al. (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12427789 Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences.] ''Gut'' 51 (6):853-9. [http://dx.doi.org/10.1136/gut.51.6.853 DOI:10.1136/gut.51.6.853] PMID: [https://pubmed.gov/12427789 12427789]</ref><ref name="pmid7557096">Abrams GA, Jaffe CC, Hoffer PB, Binder HJ, Fallon MB (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7557096 Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome.] ''Gastroenterology'' 109 (4):1283-8. PMID: [https://pubmed.gov/7557096 7557096]</ref><ref name="pmid14708947">Lima BL, França AV, Pazin-Filho A, Araújo WM, Martinez JA, Maciel BC et al. (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14708947 Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome.] ''Mayo Clin Proc'' 79 (1):42-8. [http://dx.doi.org/10.4065/79.1.42 DOI:10.4065/79.1.42] PMID: [https://pubmed.gov/14708947 14708947]</ref><ref name="pmid11434610">Martínez GP, Barberà JA, Visa J, Rimola A, Paré JC, Roca J et al. (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11434610 Hepatopulmonary syndrome in candidates for liver transplantation.] ''J Hepatol'' 34 (5):651-7. PMID: [https://pubmed.gov/11434610 11434610]</ref><ref name="pmid14517788">Schenk P, Schöniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G, Müller C (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14517788 Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis.] ''Gastroenterology'' 125 (4):1042-52. PMID: [https://pubmed.gov/14517788 14517788]</ref>
*Nevertheless, serial pulse oximetry as a simple, low cost and widely available technique, is recommended in cirrhotic patients. It could detect and also determine the severity of hypoxemia in patients with hepatopulmonary syndrome. Hence, pulse oximetry screening might improve management of HPS in cirrhotic patients.<ref name="pmid17392034">Arguedas MR, Singh H, Faulk DK, Fallon MB (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17392034 Utility of pulse oximetry screening for hepatopulmonary syndrome.] ''Clin Gastroenterol Hepatol'' 5 (6):749-54. [http://dx.doi.org/10.1016/j.cgh.2006.12.003 DOI:10.1016/j.cgh.2006.12.003] PMID: [https://pubmed.gov/17392034 17392034]</ref><ref name="pmid12427789">Schenk P, Fuhrmann V, Madl C, Funk G, Lehr S, Kandel O et al. (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12427789 Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences.] ''Gut'' 51 (6):853-9. [http://dx.doi.org/10.1136/gut.51.6.853 DOI:10.1136/gut.51.6.853] PMID: [https://pubmed.gov/12427789 12427789]</ref><ref name="pmid7557096">Abrams GA, Jaffe CC, Hoffer PB, Binder HJ, Fallon MB (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7557096 Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome.] ''Gastroenterology'' 109 (4):1283-8. PMID: [https://pubmed.gov/7557096 7557096]</ref><ref name="pmid14708947">Lima BL, França AV, Pazin-Filho A, Araújo WM, Martinez JA, Maciel BC et al. (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14708947 Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome.] ''Mayo Clin Proc'' 79 (1):42-8. [http://dx.doi.org/10.4065/79.1.42 DOI:10.4065/79.1.42] PMID: [https://pubmed.gov/14708947 14708947]</ref><ref name="pmid11434610">Martínez GP, Barberà JA, Visa J, Rimola A, Paré JC, Roca J et al. (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11434610 Hepatopulmonary syndrome in candidates for liver transplantation.] ''J Hepatol'' 34 (5):651-7. PMID: [https://pubmed.gov/11434610 11434610]</ref><ref name="pmid14517788">Schenk P, Schöniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G, Müller C (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14517788 Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis.] ''Gastroenterology'' 125 (4):1042-52. PMID: [https://pubmed.gov/14517788 14517788]</ref>
*Nevertheless, serial pulse oximetry as a simple, low cost and widely available technique, is recommended in cirrhotic patients. It could detect and also determine the severity of hypoxemia in patients with hepatopulmonary syndrome. Hence, pulse oximetry screening might improve management of HPS in cirrhotic patients.<ref name="pmid17392034">Arguedas MR, Singh H, Faulk DK, Fallon MB (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17392034 Utility of pulse oximetry screening for hepatopulmonary syndrome.] ''Clin Gastroenterol Hepatol'' 5 (6):749-54. [http://dx.doi.org/10.1016/j.cgh.2006.12.003 DOI:10.1016/j.cgh.2006.12.003] PMID: [https://pubmed.gov/17392034 17392034]</ref>
 
==Screening Algorithm==
[[Image:HPS clinical screening algorithm.png|thumb|left|700px|'''HPS clinical screening algorithm.''' Artwork by: Soroush Seifirad, MD based on Inna Krynytska et al. recommendations. ''Hepatopulmonary syndrome (HPS). SaO2: arterial oxygen saturation; CEEC: contrast enhanced echocardiography; 99mTc-MAA: lung perfusion scintigraphy with technetium 99mTc labeled macro aggregated albumin; AaPO2: alveolar-arterial oxygen tension difference; PaO2: partial pressure of oxygen; ABG: Arterial blood gas analysis.'']]
<ref name="pmid28759737">Krynytska I, Marushchak M, Mikolenko A, Bob A, Smachylo I, Radetska L et al. (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=28759737 Differential diagnosis of hepatopulmonary syndrome (HPS): Portopulmonary hypertension (PPH) and hereditary hemorrhagic telangiectasia (HHT).] ''Bosn J Basic Med Sci'' 17 (4):276-285. [http://dx.doi.org/10.17305/bjbms.2017.2020 DOI:10.17305/bjbms.2017.2020] PMID: [https://pubmed.gov/28759737 28759737]</ref>
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category: (name of the system)]]
[[Category:Surgery]]
[[Category:Medicine]]
[[Category:Pulmonology]]
[[Category:Cardiology]]
[[Category:Gastroentrology]]
[[Category:Up-To-Date]]

Latest revision as of 17:58, 6 September 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

There is insufficient evidence to recommend routine screening for hepatopulmonary syndrome. Nevertheless, it should be considered as a differential diagnosis in every patient with known liver disease or sign and symptoms of liver disease that present with hypoxemia, and dyspnea. Nevertheless, serial pulse oximetry as a simple, low cost and widely available technique, is recommended in cirrhotic patients. It could detect and also determine the severity of hypoxemia in patients with hepatopulmonary syndrome. Hence, pulse oximetry screening might improve management of HPS in cirrhotic patients.

Screening

  • There is insufficient evidence to recommend routine screening for hepatopulmonary syndrome. Nevertheless, it should be considered as a differential diagnosis in every patient with known liver disease or sign and symptoms of liver disease that present with hypoxemia, and dyspnea.[1][2][3][4][5]
  • Nevertheless, serial pulse oximetry as a simple, low cost and widely available technique, is recommended in cirrhotic patients. It could detect and also determine the severity of hypoxemia in patients with hepatopulmonary syndrome. Hence, pulse oximetry screening might improve management of HPS in cirrhotic patients.[6]

Screening Algorithm

HPS clinical screening algorithm. Artwork by: Soroush Seifirad, MD based on Inna Krynytska et al. recommendations. Hepatopulmonary syndrome (HPS). SaO2: arterial oxygen saturation; CEEC: contrast enhanced echocardiography; 99mTc-MAA: lung perfusion scintigraphy with technetium 99mTc labeled macro aggregated albumin; AaPO2: alveolar-arterial oxygen tension difference; PaO2: partial pressure of oxygen; ABG: Arterial blood gas analysis.

[7]



















References

  1. ↑ Schenk P, Fuhrmann V, Madl C, Funk G, Lehr S, Kandel O et al. (2002) Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 51 (6):853-9. DOI:10.1136/gut.51.6.853 PMID: 12427789
  2. ↑ Abrams GA, Jaffe CC, Hoffer PB, Binder HJ, Fallon MB (1995) Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome. Gastroenterology 109 (4):1283-8. PMID: 7557096
  3. ↑ Lima BL, França AV, Pazin-Filho A, Araújo WM, Martinez JA, Maciel BC et al. (2004) Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome. Mayo Clin Proc 79 (1):42-8. DOI:10.4065/79.1.42 PMID: 14708947
  4. ↑ Martínez GP, Barberà JA, Visa J, Rimola A, Paré JC, Roca J et al. (2001) Hepatopulmonary syndrome in candidates for liver transplantation. J Hepatol 34 (5):651-7. PMID: 11434610
  5. ↑ Schenk P, Schöniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G, Müller C (2003) Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis. Gastroenterology 125 (4):1042-52. PMID: 14517788
  6. ↑ Arguedas MR, Singh H, Faulk DK, Fallon MB (2007) Utility of pulse oximetry screening for hepatopulmonary syndrome. Clin Gastroenterol Hepatol 5 (6):749-54. DOI:10.1016/j.cgh.2006.12.003 PMID: 17392034
  7. ↑ Krynytska I, Marushchak M, Mikolenko A, Bob A, Smachylo I, Radetska L et al. (2017) Differential diagnosis of hepatopulmonary syndrome (HPS): Portopulmonary hypertension (PPH) and hereditary hemorrhagic telangiectasia (HHT). Bosn J Basic Med Sci 17 (4):276-285. DOI:10.17305/bjbms.2017.2020 PMID: 28759737
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