{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 23, Ep 3 of 3: Pulmonary, Coagulopathy, and Vascular Complications","html":"","width":"100%","height":180,"duration":988,"description":"Episode three covers the decompensated complications that do not flow primarily through splanchnic vasodilation, starting with two pulmonary syndromes that look related but are physiologically opposite. Hepatopulmonary syndrome is capillary dilation with shunt physiology, recognized by platypnea and orthodeoxia, while portopulmonary hypertension is arteriolar constriction diagnosed by right heart catheterization, and that single distinction picks the therapy and changes the transplant calculus. The episode then works the coagulopathy where the INR misleads because cirrhotic hemostasis is rebalanced rather than impaired, so paracentesis and thoracentesis need no correction. It closes on the vascular liver diseases sorted by anatomic level, Budd-Chiari, sinusoidal obstruction syndrome, portal vein thrombosis, porto-sinusoidal vascular disease, and shock liver.\n \nTopics covered\n\nHepatopulmonary syndrome and shunt physiology\nPlatypnea, orthodeoxia, and contrast echocardiography\nPortopulmonary hypertension and the transplant calculus\nHepatic hydrothorax\nRebalanced hemostasis and the misleading INR\nPeriprocedural transfusion decisions\nBudd-Chiari syndrome\nSinusoidal obstruction syndrome\nPortal vein thrombosis and tumor thrombus\n \n \nKey decisions\n\nHepatopulmonary syndrome is diagnosed by contrast echocardiography showing microbubbles in the left atrium three to six cardiac cycles after the right atrium opacifies, and an arterial oxygen below sixty earns transplant-priority exception points with transplant the only cure.\nPortopulmonary hypertension is confirmed by right heart catheterization with a mean pulmonary arterial pressure of at least twenty-five, a pulmonary vascular resistance over three Wood units, and a wedge of at most fifteen; a mean pressure at or above fifty contraindicates transplant while thirty-five to forty-five is a relative contraindication treatable with vasodilators.\nVasodilators help portopulmonary hypertension because the lesion is constriction...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}