Hepatopulmonary syndrome complicated by interstitial pneumonia and obesity with normal contrast echocardiography

Diagnosis of hepatopulmonary syndrome complicated by interstitial pneumonia and obesity is difficult because these complications can cause hypoxia. Such patients may not present with typical contrast echocardiography findings.     

肝肺综合征与气体信号分子

肝肺综合征是在慢性肝病、门静脉高压症的基础上,由多种因素共同参与、相互作用而导致低氧血症,肺血管扩张的一种疾病。肝肺综合征的发病机制较复杂且不完全明确,但气体信号分子参与了肺血管张力调节,并导致肺血管扩张。肝肺综合征预后差,严重威胁患者身体健康,积极有效地研究和防治肝肺综合征具有重要意义。本文就气体信号分子在肝肺综合征发病机制中的作用作一综述。     

Hepatopulmonary syndrome-attributed extreme hypoxemia and polycythemia revealing liver cirrhosis

We report an unusual case of severe hepatopulmonary syndrome with previously unrecognized cirrhosis, presenting with acute on chronic dyspnoea, extreme hypoxemia, secondary polycythemia as well as direct identification of arteriovenous communications on computed tomography angiography. Hepatopulmonary syndrome, defined as the combination of hepatopathy, arterial deoxygenation and pulmonary vascular dilatation, is increasingly recognized as a life-threatening complication in advanced liver disease and transplant candidacy. It is usually diagnosed in chronic liver disease patients following pre-transplant evaluation or mild dyspnea investigation. Diagnosis relies on the indirect evidence of pulmonary arteriovenous communications suggested by echocardiography with a bubble study. Clinicians need to be aware of this rare but potential acute presentation at the emergency room.     

胸部影像学诊断肝肺综合征的临床意义

目的:探讨肝肺综合征(HPS)的胸部X线及CT表现特点,病理基础及其临床意义。方法:分析经临床确诊肝硬化40例及慢性肝病无肝功能损害20例的胸部平片与CT扫描结果。结果:胸部平片表现为肺充血性改变及双下肺的粟粒状结节影,CT表现为肺底末梢血管的杵状及蜂窝状扩张,或与胸膜血管相连形成“蜘蛛痣”,肝硬化组发生率明显高于对照组。结论:胸部影像学检查是诊断肝肺综合征的重要方法,且与肝功能的损害程度密切相关。     

Second-impact syndrome.

Sports-related injuries are among the more common causes of injury in adolescents that can result in concussion and its sequelae, postconcussion syndrome and second-impact syndrome (SIS). Students who experience multiple brain injuries within a short period of time (hours, days, or weeks) may suffer catastrophic or fatal reactions related to SIS. Adolescents are particularly susceptible to the dangers of SIS, and current return-to-play guidelines may be too lenient to protect a student from SIS. Any student with signs of a concussion should receive medical evaluation and not be allowed to return to play in the current game or practice. The role of the school nurse includes being knowledgeable about management of head injuries and return-to-play guidelines, providing follow-up for athletes who have concussions, and providing education on prevention and management of head injuries.     

Compartment syndrome.

Compartment syndrome results from increased pressure in the closed compartments of the lower or upper extremities. Although it is not a common occurrence, it should be considered a possible complication whenever a patient experiences acute arterial occlusion or revascularization. If left untreated, compartment syndrome can lead to the loss of neuromuscular function, contractures, myoglobinuric renal failure, and amputation. Nurses play an integral role in the detection and treatment of compartment syndrome. Treatment is aimed at minimizing tissue damage and loss of function.     

Wolff-Parkinson-White syndrome.

Wolff-Parkinson-White (WPW) syndrome is a cardiac conduction disorder that presents with potentially life-threatening consequences. Wolff-Parkinson-White syndrome-induced dysrhythmias account for 20% of all supraventricular tachycardias that occur in the general population. Clinical presentations range from no symptoms to a sudden cardiac arrest. The risk of sudden death is always present with WPW syndrome, and it is the motivating force in the evaluation and treatment of this syndrome. Current diagnostic modalities are accurate in identifying patients with WPW syndrome, but lack the sensitivity to predict sudden cardiac death. This article reviews the history of WPW syndrome, as well as its general characteristics, diagnostic criteria, treatment modalities, and nursing implications.     

Klippel-Feil syndrome.

Nurses working with orthopaedic clients and pediatric populations may be the first to recognize the classic triad of Klippel-Feil syndrome: short neck, limitation of neck motion, and low occipital hairline. Klippel-Feil syndrome is a congenital malformation of the cervical vertebrae, with limited treatment options. Client/family education is vital to monitor and maintain function and to prevent neurologic deficits resulting from the fusions, accidents, or trauma.     

Serotonin syndrome.

Serotonin syndrome is a preventable, drug-related complication that results from increased brainstem serotonin activity, usually precipitated by the use of one or more serotonergic drugs. Its clinical presentation consists of autonomic dysfunction, alteration in mental status, and neuromuscular disorder. Early recognition and treatment is important, because this condition is potentially fatal. Management includes withdrawal of causative agents and supportive measures such as hemodynamic stabilization, sedation, temperature control, hydration, and monitoring for complications. Serotonin antagonists, specifically cyproheptadine, have been used, but the documented benefits are purely anecdotal.     

Metabolic syndrome.

This article discusses metabolic syndrome, which has recently been defined by the National Institutes of Health (2001) and affects approximately 47 million Americans. Suggestions have been included for risk factor identification, prevention measures, and intervention guidelines for the components of metabolic syndrome. Many Americans with metabolic syndrome will be in the workplace. Thus, the role of the occupational health nurse in the prevention of metabolic syndrome is vital. Prevention measures for metabolic syndrome focus on the education and encouragement of employees to attain or maintain healthy lifestyles. For employees with identified risk factors, collaboration between the occupational health nurse and the employee provide an avenue for healthy employee outcomes.     

Hepatorenal syndrome.

The exact physiologic mechanism of the hepatorenal syndrome remains unclear; however, it always develops in the presence of liver failure. A number of theories have been postulated to explain the syndrome, which are discussed in this review. None of the proposed theories is able to explain the syndrome completely, and continued research is necessary. Management of hepatorenal syndrome is directed at supporting the patient and maintaining/restoring hepatic function to prevent further renal damage. Liver transplantation has been considered an effective method of treatment for this patient population. Nursing care is supportive and focuses on maintaining the patients' internal environment and psychologic well-being.     

Klippel-Feil syndrome.

The triad of short neck, low posterior hairline and severe restriction of cervical motion is a classic definition of Klippel-Feil syndrome. The anatomic and clinical expressions of this syndrome vary widely, ranging from mild cosmetic deformity to severe disability. The diagnosis is usually apparent on lateral cervical radiographs.