American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition can develop in patients with chronic liver disease and portosystemic shunting?

1. Pulmonary artery hypertension

2. Portopulmonary hypertension

3. Chronic obtrusive pulmonary disease

4. Congestive heart failure

The correct answer is: Portopulmonary hypertension

Portopulmonary hypertension is a specific condition that can arise in patients with chronic liver disease, particularly those who develop portosystemic shunting. This phenomenon occurs when liver function is severely compromised, leading to elevated pressure in the portal venous system. As a result, there is a development of vascular changes in the pulmonary circulation. Patients with portopulmonary hypertension experience elevated pulmonary artery pressure due to the porto-pulmonary connection, which ultimately results from the interplay between liver disease and the pulmonary arterial system. This condition can lead to significant respiratory symptoms and can complicate the clinical picture of patients with liver disease. It is important to recognize and differentiate portopulmonary hypertension from other forms of pulmonary hypertension because its management may differ, particularly in the context of liver transplantation, where successful treatment of the liver condition may relieve the pulmonary hypertension. In contrast, the other choices listed do not have the same direct relationship with chronic liver disease and portosystemic shunting as portopulmonary hypertension does. Conditions like pulmonary artery hypertension and chronic obstructive pulmonary disease (COPD) are related to other pathophysiological processes and are not specifically tied to the alterations seen in liver disease. Congestive heart failure can be a consequence of various