Liver cirrhosis occurs when normal cells and tissues of the liver are replaced by fibrous scar tissue. Common causes include viral infections and alcohol abuse. Liver cirrhosis is associated with a number of complications including pulmonary edema. Pulmonary edema describes the filling of the lungs with fluid, impairing the exchange of gases between the air and blood. When cirrhosis leads to lung problems, this is the condition called the hepatopulmonary syndrome.
Oxygen
In acute pulmonary edema from cirrhosis of the liver, the fluid entering the lungs interferes with the normal exchange of gases in the lungs. The oxygen levels in the blood can drop precipitously. Oxygen is required for the cells to make energy and function. According to "Clinical Anesthesiology," low oxygen levels can cause heart rhythm problems and death. If the oxygen level is dropping, supplemental oxygen will need to be given. Lower levels of supplemental oxygen can be given with a nasal cannula, the two-pronged plastic device that fits over the nose. Higher levels of oxygen are delivered with a face-mask. Pure oxygen is delivered through a breathing tube inserted into the windpipe, or trachea.
Medical Management
Long-term oxygen therapy is the most frequently recommended management for people with symptoms of low oxygen from pulmonary edema associated with cirrhosis, according to an article in 2008 in the "New England Journal of Medicine." Treatment with antibiotics and the drugs almitrine, COX-inhibitors, beta-blockers, glucocorticoids, garlic preparation, cyclophosphamide, somatostatin and inhaled nitric oxide do not have much supporting evidence. A procedure called transjugular intrahepatic portosystemic shunt, or TIPS, diverts blood around the liver. It is sometimes advocated, but there is not enough data to fully support its use in every case.
Liver Transplantation
The most successful treatment pulmonary edema with liver failure has been liver transplantation. A person cannot survive without a functioning liver. According to the 2008 article in the "New England Journal of Medicine," persons with hepatopulmonary syndrome have poor outcomes without liver transplantation. Therefore, a diagnosis of hepatopulmonary syndrome associated with a low oxygen level indicates the need for a liver transplantation. Persons with the syndrome are given a higher priority for transplant than patients with other conditions.
References
- "Clinical Anesthesiology"; Morgan et al; 2005
- "New England Journal of Medicine"; Hepatopulmonary Syndrome --- A Liver-Induced Lung Vascular Disorder; Rodríguez-Roisin and Krowka; May 2008
