COMMENTARY

Pulmonary Complications of Cirrhosis

Rowen K. Zetterman, MD

Disclosures

January 16, 2013

In This Article

Dyspnea

Dyspnea is a frequent complaint in patients with cirrhosis.[3] Dyspnea also occurs in patients without liver disease who suffer from bronchitis, asthma, or chronic lung disease. Some disorders, such as alpha-1 antitrypsin deficiency, cystic fibrosis, and sarcoidosis, cause both liver and lung disease. Other complications of liver disease that can cause dyspnea include anemia, pulmonary hypertension, hypoxemia, ascites, abdominal distention, and pleural effusion. The cardiomyopathy of advanced liver disease can also cause dyspnea.

Dyspnea from tense ascites might only be relieved with large-volume paracentesis. Care should also be taken with this procedure, because patients with cirrhosis who have unrecognized cardiomyopathy can develop pulmonary edema following large-volume paracentesis.[4]

The patient with end-stage liver disease who complains of significant dyspnea should have a full evaluation that includes history and physical examination, complete blood count, echocardiogram, oximetry, chest x-ray, and arterial blood gases. History and physical findings include cough, platypnea (improvement of dyspnea when supine), cyanosis, clubbing, multiple arterial spiders, tachypnea, tachycardia, and signs of right heart failure, including jugular venous distention, right pleural effusion, peripheral edema, or a right ventricular gallop. Anemia can also lead to dyspnea. An echocardiogram will estimate pulmonary artery pressures and evaluate ventricular function. If pulmonary function testing is undertaken in the patient with cirrhosis who does not have intrinsic lung disease, the findings can show a reduction of total lung capacity caused by massive ascites and impaired diffusing capacity associated with hepatopulmonary syndrome. The treatment of dyspnea depends on identified and correctable factors.

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