Hepatic Hydrothorax

Hepatic hydrothorax is a large symptomatic pleural effusion that occurs in a cirrhotic patient in the absence of primary cardiopulmonary disease. It is present in approximately 5% of patients with cirrhotic ascites. It is right-sided in 85% of the cases, with the remaining 13% left-sided and 2% bilateral. The most common clinical symptom of hepatic hydrothorax is dyspnea without chest pain.

Hepatic hydrothorax is formed by ascitic fluid transferred through diaphragmatic defects that began as tiny herniated blebs but subsequently ruptured. This can be confirmed by injecting Tc99m-labeled sulfur colloid into the peritoneal cavity and demonstrating isotope in the chest area. The biochemical analysis of uncomplicated hepatic hydrothorax fluid resembles but is not identical to that of ascitic fluid, because pleural fluid is subject to different hydrostatic pressures. The total protein of pleural fluid is usually < 2.5 g/dL, but approximately 1 g/dL higher than that of ascitic fluid. The serum-pleural fluid albumin gradient is greater than 1.1 g/dL, similar to the high SAAG for cirrhotic ascites. The pleural fluid PMN count is less than 250 cells/mm3 in the absence of infection.

Management of hepatic hydrothorax is similar to that for ascites. Symptomatic relief is achievable in most patients by dietary sodium restriction and diuretics. If conservative treatment fails, therapeutic thoracentesis can promptly relieve dyspnea. In patients with both symptomatic hydrothorax and massive ascites, LVP should precede therapeutic thoracentesis.

TIPS is a therapeutic option when attempts at mobilizing fluid by repeated thoracentesis and/or medical therapy have failed. However, TIPS has been associated with a variable rate in controlling hepatic hydrothorax (Rosado and Kamath, 2003). Chemical pleurodesis or chest tube insertion combined with chemical pleurodesis is generally unsuccessful and should not be attempted. OLT remains a definitive treatment for refractory hepatic hydrothorax.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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