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Respiratory Physiology in Liver Disease

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Hepatic Critical Care

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Abstract

In this chapter, we will discuss hepatic-pulmonary pathophysiologic interactions in acute and chronic liver disease. Most of our understanding of how liver disease compromises the key functions of the respiratory system comes from studies of physiologic extremes. From these data, we can infer how milder manifestations of liver disease may contribute to abnormalities in ventilation and gas exchange. In liver disease, it is well established that optimal ventilation is most often perturbed by altered respiratory mechanics from ascites, hydrothorax, and hepatic cachexia. Ventilation-perfusion (V-Q) mismatching may be caused or worsened by compressive atelectasis from ascites or hydrothorax, imbalanced matching in hepatopulmonary syndrome, dynamic small airway collapse from increased pulmonary blood flow, or any of the various causes typically seen in hypoxemic hospitalized patients. Diffusion abnormalities also have myriad causes, and a low diffusion capacity (DLCO) without alternative explanation may represent the uncommon but well characterized hepatopulmonary syndrome. Additionally, acute liver failure may be complicated by the acute respiratory distress syndrome (ARDS), which itself hampers respiratory mechanics, V-Q matching, and gas diffusion. Patients with chronic liver disease are also at risk for ARDS as they are prone to sepsis and aspiration pneumonitis. Managing ARDS in these populations requires special consideration of extra-hepatic complications of liver failure such as elevated intracerebral pressure and tense ascites.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

COPD:

Chronic obstructive pulmonary disease

DLCO:

Diffusion capacity of lungs for carbon monoxide

HPS:

Hepatopulmonary syndrome

MELD:

Model for end-stage liver disease (score)

PCO2 :

Partial pressure of carbon dioxide

PACO2 :

Alveolar partial pressure of carbon dioxide

PaCO2 :

Arterial partial pressure of carbon dioxide

PAO2 :

Arterial partial pressure of oxygen

PaO2 :

Arterial partial pressure of oxygen

PEEP:

Positive end-expiratory pressure

V-Q:

Ventilation-perfusion

ERV:

Expiratory reserve volume

FEV1:

Forced expiratory volume in one second

FRC:

Functional residual capacity

FVC:

Forced vital capacity

TLC:

Total lung capacity

RV:

Residual volume

VC:

Vital capacity

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Authors and Affiliations

  1. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Paul Bergl M.D.

  2. Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA

    Jonathon D. Truwit M.D., M.B.A.

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  1. Paul Bergl M.D.
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Correspondence to Jonathon D. Truwit M.D., M.B.A. .

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  1. Medical Intensive Care Unit, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Rahul Nanchal

  2. Emory University, Atlanta, Georgia, USA

    Ram Subramanian

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Bergl, P., Truwit, J.D. (2018). Respiratory Physiology in Liver Disease. In: Nanchal, R., Subramanian, R. (eds) Hepatic Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-319-66432-3_3

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