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Hepatopulmonary Syndrome – causes, side effects and treatments at

Tuesday, May 08, 2018 by

Hepatopulmonary syndrome (HPS) is a rare lung complication of liver disease, characterized by widening or dilatation of arteries and veins in the lungs of people who have a chronic liver disease.

The normal diameter of the lung vessels ranges between 8 and 15 μm (micrometer) whereas when in HPS rises to between 15 and 500 μm. When the liver is not functioning properly, blood vessels in the lungs may dilate, which can lead to losing their ability to transfer oxygen to the body, which leads to hypoxemia or low levels of oxygen in the blood.

HPS occurs in approximately five to 32 percent of patients with scarring of the liver, known as cirrhosis.

The most prominent symptom of HPS is usually severe shortness of breath. Patients may also notice that their fingertips turn blue or that their fingers take on a club-like appearance.

Known symptoms and risk factors for hepatopulmonary syndrome

Dyspnea or progressive shortness of breath, at rest or upon exertion, is the most common complaint of individuals with HPS, reported in 95 percent of patients and usually developing after years of liver disease. A more specific symptom is platypnea or breathlessness experienced in the upright position which is relieved when lying down (supine position).

Other symptoms can include:

  • Enlargement of fingertips that gives them a club-like appearance referred to as digital clubbing.
  • Having a bluish discoloration of their skin called cyanosis.
  • Having a spider-like appearance of the blood vessels that are visible on your skin, known as spider angioma.
  • Having bouts of anxiety.
  • Increased heart rate.
  • Increased levels of nitric oxide.

Symptoms related to chronic liver disease (generally cirrhosis) include small red spots on the skin and abnormal vascular dilatation. Some other symptoms include infections in the brain (brain abscesses), brain bleeding and an increased number of red blood cells in the blood, known as polycythemia.

It should also be noted that HPS is not limited to patients with chronic liver disease; in fact, many patients with moderate to severe HPS have a comparatively well-preserved liver function.

Body systems harmed by hepatopulmonary syndrome

HPS primarily affects the lungs, with existing liver damage due to cirrhosis.

Food items or nutrients that may prevent hepatopulmonary syndrome

Garlic is a widely used remedy for patients with HPS. A pilot trial involving 15 patients with HPS showed that supplementation of garlic capsule (once daily for six months) significantly improved arterial oxygenation and decreased the clinical symptoms.

Other foods that help relieve HPS symptoms include:

  • Apples – Drinking apple juice was found to reduce the incidence of wheezing in children, while pregnant women who ate apples regularly were less likely to have asthmatic children. Apples contain phenolic acids and flavonoids which help reduce inflammation in the air passageways, a common feature of both asthma and wheezing.
  • Beans, nuts, seeds – Beans are excellent sources of zinc, selenium, and manganese, while nuts contain vitamin E which helps create more oxygen-rich red blood cells. Seeds such as pumpkin seeds, sunflower seeds, and flaxseeds contain magnesium, which is an important nutrient for lung health as it helps the muscles in your airways relax and reduces inflammation, making breathing easier.
  • Chili peppers – Peppers are filled with capsaicin, which improves blood flow, as well as stimulates mucus membranes and fights infection.
  • Colored fruits and veggies – Orange fruits and veggies such as carrots, oranges, pumpkins, papaya are rich sources of vitamin C and other lung-friendly antioxidants, which help fight infections and inflammation.
  • Cruciferous vegetables – Studies have shown that veggies like broccoli, Brussels sprouts, kale, and cauliflower may help reduce your risk of lung cancer, thanks to their glucosinolates content, natural compounds that have been found to inhibit the development of some types of cancer, including lung cancer.
  • Grapefruits – Grapefruit contains naringin, a flavonoid that inhibits the activation of a cancer-causing enzyme. Grapefruit is especially good at cleansing the lungs after quitting smoking.
  • Green tea – Green tea contains the antioxidant quercetin, which acts as a natural antihistamine that helps slow the release of inflammatory chemicals in the body that triggers allergy symptoms, including asthma.
  • Pomegranates – Pomegranates contain many antioxidants including ellagic acid, which helps slow the growth of lung tumors.

Treatments, management plans for hepatopulmonary syndrome

The main treatment for HPS  is supplemental oxygen for symptoms. Liver transplant is an effective treatment which improves the symptoms, even in severe cases. The following activities and lifestyle adjustments also help manage HPS:

  • Breathing exercises
  • Regular exercise
  • Quitting smoking
  • Aromatic vapor/steam
  • Cutting down fat intake
  • Being aware of pollution

Where to learn more


Hepatopulmonary syndrome is a rare lung complication of liver disease, characterized by widening or dilatation of arteries and veins in the lungs. This leads to hypoxemia or low levels of oxygen in the blood.

The most common symptom of HPS is severe shortness of breath.

Sources include:


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