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Pulmonale Komplikationen der Leberzirrhose

Hepatopulmonales Syndrom, portopulmonale Hypertonie und hepatischer Hydrothorax

Pulmonary complications of liver cirrhosis

Hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax

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Zusammenfassung

Das hepatopulmonale Syndrom, die portopulmonale Hypertonie und der hepatische Hydrothorax stellen typische pulmonale Komplikationen bei Patienten mit einer Leberzirrhose dar. Während es sich bei den ersten beiden Entitäten um pulmonalvaskuläre Krankheitsbilder handelt, sind beim hepatischen Hydrothorax typischerweise Aszites und Zwerchfellläsionen für die Entstehung der Erkrankung verantwortlich. Beim schweren hepatopulmonalen Syndrom und beim therapierefraktären hepatischen Hydrothorax stellt die Lebertransplantation die Therapie der Wahl dar, wohingegen bei der schweren portopulmonalen Hypertonie eine medikamentöse Therapie angestrebt wird. Neben intravenösen Prostazyklinderivaten stellen orale Endothelinrezeptorantagonisten und Phosphodiesterase-5-Hemmer eine Therapieoption bei ausgewählten Patienten dar.

Abstract

Hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax are typical pulmonary complications in patients with liver cirrhosis. Whereas hepatopulmonary syndrome and portopulmonary hypertension represent pulmonary vascular diseases, the development of hepatic hydrothorax is associated with the presence of ascites and phrenic lesions. For severe hepatopulmonary syndrome and refractory hepatic hydrothorax, liver transplantation is the treatment of choice. In severe portopulmonary hypertension specific medical treatment is indicated. In selected patients, beside intravenous prostanoids, oral endothelin receptor antagonists and phosphodiesterase type-5 inhibitors are possible treatment options.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    M. Halank

  2. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    C.P. Strassburg

  3. Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    M.M. Hoeper

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  1. M. Halank
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  2. C.P. Strassburg
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  3. M.M. Hoeper
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Correspondence to M. Halank.

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Halank, M., Strassburg, C. & Hoeper, M. Pulmonale Komplikationen der Leberzirrhose. Internist 51 (Suppl 1), 255–263 (2010). https://doi.org/10.1007/s00108-009-2503-y

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