Pathophysiology: Gut Liver Axis Changes
The liver is at the intersection between the gut and the systemic circulation. Consequently it is the first recipient of the by-products of digestion including nitrogenous waste and thus the factory for processing and detoxifying these compounds. In cirrhosis, this detoxification capacity is overwhelmed by a combination of impaired urea synthesis and bypassing of blood rich in ammonia directly into the systemic circulation as a result of portal hypertension. This chapter describes the pathogenesis of hepatic encephalopathy (HE) and the complex relationship between the liver and gut. The changes in gut microbiota that occur in cirrhosis and the various strategies of manipulating the gut flora to treat and prevent HE are discussed utilising an evolving typical clinical case scenario.
KeywordsAmmonia Infection Microbiome Antibiotic Probiotic Prebiotic
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