Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of Portopulmonary Hypertension (PoPH) in the setting of known portal hypertension/cirrhosis. Symptoms include progressive exertional dyspnea, fatigue, and occasional syncope. No history of left-sided heart failure or significant parenchymal lung disease. Current MELD score is [Score]. NYHA functional class is [Class].
Clinical Examination Findings
General: Patient is alert and oriented, appearing chronically ill. Cardiovascular: Loud P2, right ventricular heave, and a holosystolic murmur consistent with tricuspid regurgitation. Jugular venous distention (JVD) present. Abdomen: Evidence of ascites and hepatosplenomegaly. Extremities: Bilateral 2+ pitting edema. Lungs: Clear to auscultation bilaterally.
Treatment Protocol
Management plan includes optimization of portal hypertension, initiation of pulmonary vasodilator therapy (e.g., PDE5 inhibitors, endothelin receptor antagonists, or prostacyclin analogs) as indicated by RHC hemodynamics. Close monitoring of liver function tests and fluid status. Referral for liver transplant evaluation if hemodynamics stabilize.