Date:
Patient:
MRN:
Clincian: (Pulmonologist, Hepatologist)
Reason for Visit:
Evaluation for suspected or confirmed HPS
Review of symptoms and laboratory results
Discussion of management plan
History of Present Illness:
Briefly describe the onset and progression of symptoms:
Shortness of breath at rest or with exertion (platypnea)
Oxygen desaturation with positional changes (orthopnea)
Fatigue
History of underlying liver disease (cirrhosis is the major risk factor)
Recent hospitalization or worsening of liver function
Past Medical History:
Underlying liver disease (stage of cirrhosis)
Previous hospitalizations for respiratory issues
Other relevant medical history (e.g., diabetes, heart disease)
Social History:
Smoking history (contributing risk factor)
Physical Exam:
Vital Signs: May be normal or show signs of respiratory distress (tachypnea, hypoxia).
Finger clubbing (possible sign of chronic hypoxia).
Consider mentioning jugular venous distention (JVD) on neck exam if present (suggestive of right heart dysfunction).
Chest exam:
Bibasilar crackles (rales) on auscultation.
Labs:
Arterial blood gas (ABG):
May show hypoxemia (low oxygen levels) with normal or near-normal CO2 levels.
Liver function tests (LFTs):
Usually abnormal and reflect the underlying liver disease.
Consider mentioning other labs ordered as needed (complete blood count, coagulation studies).
Imaging:
Chest X-ray:
May be normal or show nonspecific findings (increased interstitial markings).
Echocardiogram:
May show signs of right ventricular dysfunction due to pulmonary hypertension.
Consider mentioning the use of lung function tests (spirometry) which may be normal or show mild restrictive pattern in HPS.
Assessment:
Summarize the diagnosis of HPS based on clinical presentation (platypnea, orthopnea), underlying liver disease, and supportive findings on labs and imaging.
Discuss the severity of HPS based on symptoms and oxygen requirements.
Consider mentioning the use of specific diagnostic criteria (e.g., Seattle criteria) for HPS diagnosis if applicable.
Plan:
Outline the management plan which focuses on treating the underlying liver disease and improving oxygenation:
Liver-directed therapies:
Management of ascites and other complications of cirrhosis to improve liver function.
Consideration of liver transplantation in select cases.
Oxygen therapy:
Supplemental oxygen to maintain adequate oxygen levels.
Diuretics:
Careful use of diuretics to manage fluid overload without worsening HPS.
Vasodilators:
In some cases, medications to reduce pulmonary artery pressure may be considered.
Lifestyle modifications:
Smoking cessation is crucial.
Weight loss if overweight or obese.
Consider mentioning referral to a multidisciplinary team for comprehensive management.
Prognosis:
Briefly discuss the prognosis. Prognosis depends on the severity of HPS and the underlying liver disease.
Early diagnosis and treatment of both HPS and liver disease can improve outcomes.
Advanced HPS can lead to respiratory failure and death.
Education:
Document any education provided to the patient regarding:
The nature of HPS and its link to liver disease
The importance of adhering to the treatment plan and medication use
Lifestyle modifications to improve oxygenation and overall health
The importance of regular follow-up and monitoring
Palliative care options for advanced disease
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the diagnosis and treatment plan, and any concerns they may have about treatment side effects, prognosis, or limitations.
Address the potential emotional impact of a chronic illness and offer support or referral for mental health services if needed.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a pulmonologist, hepatologist, or other specialists involved in the patient’s care for diagnosis, treatment recommendations, and prognosis.