Question

1. Please explain the differences between pulmonary hypertension and pulmonary edema, and the relationship (cause/outcome) between them.

2. What are the potential conditions associated with hepatomegaly and/or splenomegaly? Explain the pathogenesis of hepatomegaly for each condition.

Answer 1

Ans) 1) Pulmonary hypertension (PH) is a rare but severe disease characterized by high blood pressure in the lungs.

- The disease affects the pulmonary arteries, which are responsible for transporting the blood from the right heart ventricle to the lungs, making them narrowed and blocked. In order to properly pump the blood, the heart needs to work harder, in danger of becoming enlarged and weakened.

- Ultimately, pulmonary hypertension can result in right heart failure and even death.

- Many symptoms can suggest the onset of the disease, including shortness of breath (dyspnea), fatigue, dizziness or fainting spells (syncope), pain or pressure in the chest, swollen abdomen (ascites), bluish color in the lips and skin (cyanosis), or irregular heart beat. Edema, an abnormal buildup of fluid in the ankles, legs or lungs, is also among the possible signs of pulmonary hypertension.

- The alveoli present in the lungs are normally filled with air during the breathing process, but in certain circumstances, the alveoli may fill with fluid rather than air.

- There are numerous reasons for the accumulation of fluid in the lungs, the most common being related to heart problems.

- Edema in pulmonary hypertension prevents oxygen from being absorbed into the bloodstream, since the heart isn’t capable of properly pumping the blood back up into the pulmonary arteries.

- When the blood pressure starts to raise, the fluid is pushed in the alveoli, reducing the normal oxygen movement. Swelling in the ankles or legs is associated with heart failure.

“When cardiac conditions cause edema, it is due to the development of left or right ventricular dysfunction. When pulmonary diseases initiate edema formation, it is a result of right ventricular dysfunction. A previous study from our group identified an association between bilateral leg edema and pulmonary hypertension, with many of the subjects with pulmonary hypertension having no evidence of cardiac or pulmonary disease,” as explained in the study.

2) Hepatosplenomegaly (commonly abbreviated HSM) is the simultaneous enlargement of both the liver (hepatomegaly) and the spleen (splenomegaly). Systemic venous hypertension can also increase the risk for developing hepatosplenomegaly, which may be seen in those patients with right-sided heart failure.

- The mechanism of hepatomegaly consists of vascular swelling, inflammation (due to the various causes that are infectious in origin) and deposition of (1) non-hepatic cells or (2) increased cell contents (such due to iron in hemochromatosis or hemosiderosis and fat in fatty liver disease).