COMMENTARY

Pulmonary Complications of Cirrhosis

Rowen K. Zetterman, MD

Disclosures

January 16, 2013

In This Article

The Far-Reaching Effects of Cirrhosis

Cirrhosis of the liver is a leading cause of death in the United States. It can reduce systemic vascular resistance and increase sodium retention by the kidney, causing increased intravascular volume and hyperdynamic circulation. These changes are associated with the classic complications of portal hypertension, including ascites, gastroesophageal varices, and hepatic encephalopathy of varying clinical severity. Cardiopulmonary complications are also frequent in patients with end-stage liver disease and it is important to evaluate pulmonary complaints in the patient with cirrhosis. The symptoms can be a consequence of liver disease but can also be related to risk factors such as smoking, alcohol consumption, nutritional deficiencies, and autoimmune disorders. Lung compliance can be reduced when the diaphragm is elevated from ascites and hepatomegaly or from intrathoracic changes of volume overload, atelectasis, or effusion. In addition, deconditioning and muscle wasting associated with end-stage liver disease can aggravate dyspnea,[1] resulting in limited pulmonary reserve. Chronic underlying lung disease, such as emphysema from smoking, chronic bronchitis, or asthma, may also be present. It is crucial that patients being considered for liver transplantation stop smoking before the surgery because of an increased risk for postoperative complications such as hepatic artery thrombosis.[2]

Pulmonary complications associated with cirrhosis include dyspnea, atelectasis, restriction of diaphragmatic excursion from massive ascites, pulmonary hypertension, hepatopulmonary hypoxemia, pleural effusions, and pneumonia.

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