Critical Matters

Management Of Acute - On - Chronic Liver Failure: Part 2

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Jan 14, 2021
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ADVICE

Manage Portopulmonary Hypertension

  • Treat portopulmonary hypertension to reduce pulmonary artery pressures below 35 mmHg.
  • Refer liver disease patients with pulmonary hypertension to transplant centers for optimal management and transplant eligibility.
INSIGHT

Hepatopulmonary Syndrome Insights

  • Hepatopulmonary syndrome causes intrapulmonary vascular dilations leading to severe hypoxemia characterized by orthodeoxia and platypnea.
  • It is often reversible with liver transplant, making supportive care and transplant evaluation critical.
ADVICE

Manage Hepatic Hydrothorax

  • Use TIPS to decrease portal pressures and manage hepatic hydrothorax when possible.
  • If TIPS is not an option, consider therapeutic thoracentesis or pleural drainage to relieve symptoms, which may lead to spontaneous pleurodesis.
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