Respiration and Circulation in Patients with Portal Cirrhosis of the Liver

IT IS generally known that cirrhosis of the liver may be accompanied by marked changes in the hepatic and splanchnic vascula- ture, which in turn lead to reduced hepatic blood flow, increased portal venous pressure, and the development of collateral vessels per- mitting bypass of the diseased liver.'-7Less well known is the fact that cirrhosis of the liver may also be associated with changes in the respiratory pattern, the pulmonary vas- culature, and the systemic circulation.8-10Information on this subject is at present in- complete.It may even seem questionable that impairment of the function of a single organ can lead to such a varied pathologic pattern.This review attempts to fulfill a dual purpose: first, to draw attention to the above-mentioned, less well known complications of cirrhosis of the liver, and, secondly, to present a more unified concept of the respiration and circula- tion in patients with this disease.Patients with cirrhosis of the liver may hyperventilate at rest in the absence of re- duced hemoglobin content of the blood and without apparent increase in oxygen consump- tion.This leads to the development of mild respiratory alkalosis.10To explain the hyper- ventilation in the face of reduced carbon diox- ide tension and normal, or slightly elevated, pH of the arterial blood, the assumption is often made that the respiratory center is stim- ulated by ammonia, because the blood level of