Portopulmonary hypertension vs Hepatopulmonary syndrome

Both complications of liver disease but with distinct characteristics
Hepatopulmonary syndrome → dilated pulmonary vasculature and angiogenesis → shunt (increased A-a gradient) →
hypoxemia (orthodeoxia - worse when sitting up / standing, better lying down)
dyspnea (platypnea - worse when sitting up / standing, better lying down)
bubbles R to L heart in 3-6 beats
Dx: chronic liver function, A-a gradient, hypoxia, and echo with bubble/agitated saline
Tx: liver transplant (resolves hypoxemia within one year
Portopulmonary hypertension → pulmonary vasoconstriction and vascular obstruction due to proliferation of smooth muscle, endothelium, and platelet aggregation →
mean pulmonary arterial pressure of 25 mmHg at rest or 30 mmHg while exercising
mean pulmonary arterial occlusion pressure less than 15 mmHg
elevated pulmonary vascular resistance greater than 3 Wood units
portal hypertension
dyspnea, weakness, low exercise tol
Dx: TTE, right heart cath
Tx: Diuresis, vasodilators (prostanoids, PDEi, endothelin antagonists)

[@dakota780]

was this supposed to be super sped up?

[@dakota780]

was this supposed to be super sped up?