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Inflammation and Hepatic Encephalopathy

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Book cover Hepatic Encephalopathy

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

The pivotal role of ammonia in the pathogenesis of HE in acute liver failure is incontrovertible, but in chronic liver disease a consistent correlation between the concentration of ammonia in the blood and the manifest symptoms of HE is not always observed. Over the past decade, we have begun to characterise the important roles of inflammation, infection, and oxidative stress in modulating the pathophysiological effects of ammonia on the astrocyte, the most commonly affected cell neuropathologically. The synergistic role of inflammation and infection in modulating the cerebral effects of ammonia has been demonstrated and a degree of overlap with sepsis-associated encephalopathy has been postulated. Ammonia may “sensitise” the brain to a systemic inflammatory stimulus which results in a response involving proinflammatory and neurotransmitter pathways. Brain microglial activation may also be implicated. Ammonia has also been shown to induce immune dysfunction with the release of reactive oxygen species from neutrophils which contribute to oxidative stress and systemic inflammation. Not only can this exacerbate the cerebral effects of ammonia but it may also make the individual vulnerable to developing infection which will further predispose to the manifestation of covert or overt HE. This chapter explores the current thoughts and evidence base on this area and discusses the role of existing and novel therapies that might be utilised in those predisposed to developing HE.

The authors Shabnam S. Shabbir and Amit Singh Seyan contributed equally to this chapter.

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Authors and Affiliations

  1. King’s College School of Medicine, King’s College London, London, UK

    Shabnam S. Shabbir BSc, MBBS & Amit Singh Seyan MBBS, BSc (Hons)

  2. Institute of Liver Studies, King’s College School of Medicine at King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Debbie Lindsay Shawcross BSc, MBBS, FRCP, PhD

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  1. Shabnam S. Shabbir BSc, MBBS
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  2. Amit Singh Seyan MBBS, BSc (Hons)
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  3. Debbie Lindsay Shawcross BSc, MBBS, FRCP, PhD
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Correspondence to Debbie Lindsay Shawcross BSc, MBBS, FRCP, PhD .

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Editors and Affiliations

  1. , Division of Gastroenterology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, 44145, USA

    Kevin D. Mullen

  2. , Division of Gastroenterology, MetroHealth Medical Center, 2500 MetroHealth Medical Center, Cleveland, 44145, USA

    Ravi K. Prakash

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Shabbir, S.S., Seyan, A.S., Shawcross, D.L. (2012). Inflammation and Hepatic Encephalopathy. In: Mullen, K., Prakash, R. (eds) Hepatic Encephalopathy. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-836-8_4

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  • DOI: https://doi.org/10.1007/978-1-61779-836-8_4

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