# Hepatopulmonary Syndrome: Liver Disease With a Gas-Exchange Problem

Intrapulmonary shunting and elevated pulmonary vascular resistance are different physiological problems. The diagnostic distinction changes management.

![Infographic: Hepatopulmonary Syndrome: Liver Disease With a Gas-Exchange Problem](https://urinenephrology.org/visual-reference/images/mastery-hps.png?v=20261003c)

## Intrapulmonary vascular change

Hepatopulmonary syndrome links liver disease or portal hypertension with abnormal pulmonary vascular dilatation and impaired oxygenation.

## Recognize positional symptoms

Dyspnea, hypoxemia, or worsening oxygenation upright can raise suspicion. Other cardiac and pulmonary causes still need assessment.

## Confirm the three components

Look for liver disease or portal hypertension, an oxygenation defect assessed with room-air arterial blood gas when appropriate, and intrapulmonary vascular dilatation on contrast echocardiography. Delayed left-heart appearance of microbubbles supports intrapulmonary passage; interpret timing with the imaging team and other possible shunts.

## Provide supportive care

Oxygen support and management of liver-related complications are individualized. Coordinate specialist evaluation and transplant consideration where appropriate.

## Assess procedure risk

Severity of hypoxemia, coexisting disease, and transplant planning affect perioperative and critical-care decisions.

## Do not confuse two liver–lung syndromes

Hepatopulmonary syndrome is a gas-exchange problem from abnormal pulmonary vascular dilatation/shunting. Portopulmonary hypertension involves elevated pulmonary vascular resistance and requires hemodynamic evaluation. A low oxygen saturation alone does not distinguish them, and their treatment pathways differ.

## Source lessons

- [hepatopulmonary](https://urinenephrology.org/mastery/hepatorenal/hepatopulmonary.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.