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Hepatic Encephalopathy

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Diseases of the Liver and Bile Ducts

Part of the book series: Current Clinical Practice ((CCP))

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Abstract

Hepatic encephalopathy is a reversible decrease in the level of consciousness occurring as a consequence of liver disease. The manifestations of hepatic encephalopathy vary, and this diagnosis should be considered in any critically ill patient with altered mental status and evidence of liver disease. Prompt diagnosis and treatment may prevent further complications in severely ill patients, and improve the quality of life in patients with more subtle disease.

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References

  1. Conn HO. Hepatic encephalopathy. In: Schiff L, Schiff ER, eds. Diseases of the liver, 7th ed. Lippincott, Philadelphia, 1993, pp. 1036–1060.

    Google Scholar 

  2. Blei AT, Finn B. Hepatic encephalopathy. In: Bayless TM, ed. Current therapy in gastroenterology and liver disease, 4th ed. Mosby, St. Louis, MO, 1994, pp. 524–528.

    Google Scholar 

  3. Lockwood AH, Yap EWH, Wong WH. Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cerebr Blood Flow 1991;11:337–341.

    Article  CAS  Google Scholar 

  4. Lavoie J, Giguere JF, Pomier Layrargues G, Butterworth RF. Amino acid changes in autopsied brain tissue from cirrhotic patients with hepatic encephalopathy. J Neurochem 1987;49:692–697.

    Article  PubMed  CAS  Google Scholar 

  5. Oei LT, Kuys J, Lombarts AJ, Goor C, Endtz LJ. Cerebrospinal fluid glutamine levels and EEG findings in patients with hepatic encephalopathy. Clin Neurol Neurosurg 1979;81:59–63.

    Article  PubMed  CAS  Google Scholar 

  6. Mullen KD, Szauter KM, Kaminsky-Russ K. “Endogenous” benzodiazepine activity in body fluids of patients with hepatic encephalopathy. Lancet 1990;1:81–83.

    Article  Google Scholar 

  7. Basile AS, Huges RD, Harrison PM, et al. Elevated brain concentrations of 1,4-benzodiazepines in fulminant hepatic failure. N Engl J Med 1991;325:473–478.

    Article  PubMed  CAS  Google Scholar 

  8. Rosen HM, Yoshimura N, Hodgman JM, Fischer JE. Plasma amino acid patterns in hepatic encephalopathy of differing etiology. Gastroenterology 1977;72:483–487.

    PubMed  CAS  Google Scholar 

  9. Zieve L, Shekleton M, Lyftogt C, Draves K. Ammonia, octanoate and a mercaptan depress regeneration of normal rat liver after partial hepatectomy. Hepatology 1985;5:28–31.

    Article  PubMed  CAS  Google Scholar 

  10. Schomerus H, Hamster W, Blunck H, et al. Latent portosystemic encephalopathy. I. Nature of cerebral function defects and their effect on fitness to drive. Dig Dis Sci 1981;26:622–630.

    Article  PubMed  CAS  Google Scholar 

  11. Schafer DF, Jones EA. Hepatic encephalopathy. In: Zakim D, Boyer TD, eds. Hepatology. A textbook of liver disease, 2nd ed. Saunders, Philadelphia, 1990, pp. 447–460.

    Google Scholar 

  12. Mas A, Salmeron JM, Rodes J. Diagnosis and therapy of hepatic encephalopathy. Ad Exp Med Biol 1994;368:119–123.

    Article  CAS  Google Scholar 

  13. Conn HO. The trailmaking and number connection tests in assessing mental state in portosystemic encephalopathy. Am J Dig Dis 1977;22:541–550.

    Article  PubMed  CAS  Google Scholar 

  14. Finlayson MAJ, Johnson KA, Reitan RM. Relationship of education to neurophysiological measures in braindamaged and non-brain-damaged adults. J Consult Clin Psychol 1977;45:536–542.

    Article  PubMed  CAS  Google Scholar 

  15. Conn HO, Lieberthal MM. The hepatic coma syndromes and lactulose. Williams & Wilkins, Baltimore, 1979.

    Google Scholar 

  16. Conn HO, Leey CM, Vlahcevic ZR, et al. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy: a double-blind controlled trial. Gastroenterology 1977;72:573–583.

    PubMed  CAS  Google Scholar 

  17. Aguglia U, Gambardella A, Oliveri RL, Lavano A, Quattrone A. Nonmetabolic causes of triphasic waves: a reappraisal. Electroencephalogr 1990;21:120–125.

    CAS  Google Scholar 

  18. Kullmann F, Hollerbach S, Holstege A, Scholmerich J. Subclinical hepatic encephalopathy: the diagnostic value of evoked potentials. J Hepatology 1995;22:101–110.

    Article  CAS  Google Scholar 

  19. Kreis R, Ross BD, Farrow NA, Ackerman Z. Metabolic disorders of the brain in chronic hepatic encephalopathy detected with H-1 MR spectroscopy. Radiology 1992; 182:19–27.

    PubMed  CAS  Google Scholar 

  20. Teran JC, McCullough AJ, Mullen KD. A three-step nutritional approach to patients with hepatic encephalopathy. J Crit Illness 1995;10:309–316.

    Google Scholar 

  21. Naylor CD, O’Rourke K, Detsky AS, Baker JP. Parental nutrition with branched-chain amino acids in hepatic encephalopathy. A meta-analysis. Gastroenterology 1989;97:1033–1042.

    PubMed  CAS  Google Scholar 

  22. Weber FL Jr. The effect of lactulose on urea metabolism and nitrogen excretion in cirrhotic patients. Gastroenterology 1979;77:518–523.

    PubMed  Google Scholar 

  23. Nelson DC, McGrew WR, Hoyumpa AM. Hypernatremia and lactulose therapy. JAMA 1983; 249:1295–1298.

    Article  PubMed  CAS  Google Scholar 

  24. Uribe M, Marquez MA, Garcia-Ramos G, et al. Treatment of chronic portal-systemic encephalopathy with lactose in Lactase-deficient patients. Dig Dis Sci 1980;25:924–928.

    Article  PubMed  CAS  Google Scholar 

  25. Camma C, Fiorello F, Tine F, Marchesini G, Fabbri A, Pagliaro L. Lactitol in treatment of chronic hepatic encephalopathy: a meta-analysis. Dig Dis Sci 1993;38:916–922.

    Article  PubMed  CAS  Google Scholar 

  26. Orlandi F, Freddara U, Candelaresi MT, et al. Comparison between neomycin and lactulose in 173 patients with hepatic encephalopathy: a randomized clinical study. Dig Dis Sci 1981;26:498–506.

    Article  PubMed  CAS  Google Scholar 

  27. Weber FL Jr, Fresard KM, Lally BR. Effects of lactulose and neomycin on urea metabolism in cirrhotic subjects. Gastroenterology 1982;82:213–217.

    PubMed  Google Scholar 

  28. Morgan MH, Read AE, Speller DC. Treatment of hepatic encephalopathy with metronidazole. Gut 1982;23:1–7.

    Article  PubMed  CAS  Google Scholar 

  29. Bucci L, Palmieri GC. Double-blind, double-dummy comparison between treatment with rifaximin and lactulose in patients with medium to severe degree hepatic encephalopathy. Curr Med Res Opin 1993; 12:109–118.

    Article  Google Scholar 

  30. Parini P, Cipolla A, Ronchi M, Salzetta A, Mazzella G, Roda E. Effect of rifaximin and paromomycin in the treatment of portal-systemic encephalopathy. Curr Ther Res 1992;52:34–39.

    Article  Google Scholar 

  31. Gooday R, Hayes PC, Bzeizi K, O’Carroll RE. Benzodiazepine receptor antagonism improves reaction time in latent hepatic encephalopathy. Psychopharmacology 1995; 119:295–298.

    Article  PubMed  CAS  Google Scholar 

  32. Reding P, Duchateau J, Bataille C. Oral zinc supplementation improves hepatic encephalopathy. Results of a randomized controlled trial. Lancet 1984;2:493–495.

    Article  PubMed  CAS  Google Scholar 

  33. Sashimi S, Dasarathy S, Tandon RK, Jain S, Gupta S, Bhist M. Sodium benzoate in the treatment of acute hepatic encephalopathy: a double-blind randomized trial. Hepatology 1992; 16:138–144.

    Google Scholar 

  34. Uflacker R, Silva Ade O, d’ Albuquerque LA, Piske RL, Mourao GS. Chronic portal-systemic encephalopathy: embolization of portal-systemic shunts. Radiology 1987; 165:721–725.

    PubMed  CAS  Google Scholar 

  35. Hauenstein KH, Haag K, Ochs A, Langer M, Rosse M. The reducing stent: treatment for transjugular intrahe-patic portosystemic shunt-induced refractory hepatic encephalopathy and liver failure. Radiology 1995;194:175–179.

    PubMed  CAS  Google Scholar 

  36. Tarter RE, Switala J, Plail J, Havrilla J, Van Thiel DH. Severity of hepatic encephalopathy before liver transplantation is associated with quality of life after transplantation. Arch Intern Med 1992; 152:2097–2101.

    Article  PubMed  CAS  Google Scholar 

  37. Atillasoy E, Berk PD. Fulminant hepatic failure: pathophysiology, treatment, and survival. Annu Rev Med 1995;46:181–191.

    Article  PubMed  CAS  Google Scholar 

  38. Hoofnagle JH, Carithers RL, Shapiro C, Ascher N. Fulminant hepatic failure: summary of a workshop. Hepatology 1995;21:240–252.

    PubMed  CAS  Google Scholar 

  39. Williams R, Wendon J. Indications for orthotopic liver transplantation in fulminant liver failure. Hepatology 1994;20:5S–10S.

    Google Scholar 

  40. Christensen E, Krintel JJ, Hansen SM, Johansen JK, Juhl E. Prognosis after the first episode of gastrointestinal bleeding or coma in cirrhosis. Survival and prognostic factors. Scand J Gastroenterol 1989;24:999–1006.

    Article  PubMed  CAS  Google Scholar 

  41. Jalan R, Elton RA, Redhead DN, Finlayson NDC, Hayes PC. Analysis of prognostic variables in the prediction of mortality, shunt failure, variceal rebleeding and encephalopathy following the transjugular intrahepatic portosystemic stent-shunt for variceal hemorrhage. J Hepatol 1995;23:123–128.

    Article  PubMed  CAS  Google Scholar 

Suggested Reading

  1. Conn HO. Hepatic encephalopathy. In: Schiff L, Schiff ER, eds. Diseases of the liver, 7th ed. Lippincott, Philadelphia, 1993, pp. 1036–1060.

    Google Scholar 

  2. Blei AT, Finn B. Hepatic encephalopathy. In: Bayless TM, ed. Current therapy in gastroenterology and liver disease, 4th ed. Mosby, St. Louis, MO, 1994, pp. 524–528.

    Google Scholar 

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Authors
  1. Karen K. Kormis
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  2. George Y. Wu
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Editor information

Editors and Affiliations

  1. University of Connecticut School of Medicine, Farmington, CT, USA

    George Y. Wu MD, PhD

  2. Hartford Hospital, Hartford, CT, USA

    Jonathan Israel MD

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© 1998 Springer Science+Business Media New York

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Kormis, K.K., Wu, G.Y. (1998). Hepatic Encephalopathy. In: Wu, G.Y., Israel, J. (eds) Diseases of the Liver and Bile Ducts. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-1808-1_28

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  • DOI: https://doi.org/10.1007/978-1-4612-1808-1_28

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4612-7293-9

  • Online ISBN: 978-1-4612-1808-1

  • eBook Packages: Springer Book Archive

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