Both portopulmonary hypertension and hepatopulmonary syndrome are relatively uncommon causes of dyspnoea, but should be considered in patients with portal hypertension in whom other common causes have been excluded. This case study highlights these alternative causes of dyspnoea in patients with chronic liver disease. A 58 year old male with known alcoholic cirrhosis presented with increasing dyspnoea and abdominal swelling. His shortness of breath persisted despite large volume paracentesis. His blood gas revealed a severe hypoxia and a transthoracic echocardiogram showed a severely elevated pulmonary artery systolic pressure. Right heart catheterisation confirmed severe pulmonary hypertension. Liver transplantation was contraindicated due to the severity of the pulmonary hypertension therefore medical treatment was focussed on symptom control. He was started on sildenafil 25 mg three times daily and the patient reported some improvement in symptoms after 3 months of treatment.

Shortness of breath (SOB) is a common presenting complaint and the differential diagnoses are vast. There is a group of patients where the cause of shortness of breath is their underlying liver disease. A common cause of shortness of breath as a direct result of liver disease is abdominal ascites. The fluid in the peritoneal cavity, when in large volumes, can put pressure on the diaphragm. This means the lungs are unable to inflate to full capacity and causes SOB. A hepatic hydrothorax occurs when abdominal ascites translocates into the pleural cavity. This can be managed with diuretics. In some cases a pleural aspiration can be considered for symptomatic relief.

Two other conditions exist which can also cause SOB in chronic liver disease and will be the main focus of this case study; Hepatopulmonary syndrome (HPS) and Portopulmonary hypertension (PPH). These two conditions are both ultimately caused by liver damage but have different pathogenesis, presentation, management and prognosis.

Microbial profile and antibiotic sensitivity pattern in acute bacterial cholangitis

Introduction The changing antimicrobial sensitivity pattern of causative organisms poses a therapeutic challenge in treating patients with acute cholangitis. We therefore evaluated the microbial profile and sensitivity pattern to antibiotics in patients with acute bacterial cholangitis. Methods Data of patients above 18 years of age with acute bacterial cholangitis seen between January 2004 and March 2007 were retrospectively analyzed. The study was continued prospectively from April 2007 to December 2008. Data on clinical features, etiological and microbial profile and therapy, and patient outcomes were analyzed. In the prospective group, the antibiotic susceptibility patterns of organisms grown on bile and blood culture were also obtained

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