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Hepatische Enzephalopathie

  • W. F. Caspary

Zusammenfassung

Bei der hepatischen Enzephalopathie (HE)—oder portosystemischen Enzephalopathie (PSE)- besteht eine Störung neurologischer Funktionen bedingt durch eine Störung der Leberfunktion, Die HE kommt häufig bei Patienten mit portaler Hypertension und Shunting des Blutes an der Leber vorbei vor. Bei chronischen Leberkrankheiten beginnt sie häufig rasch und ist charakterisiert durch Gedächtnisstörungen, Persönlichkeitsveränderungen, Konzentrationsschwäche und Reaktionsverlangsamung. Frühzeitige Manifestationen sind klinisch kaum, häufig nur retrospektiv, erkennbar. Trotzdem kann die latente Enzephalopathie klinisch relevant werden (z. B. Fahruntüchtigkeit bis zu 50%).

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Literatur

  1. Barbaro G, Dilorenzo G, Soldini M, et al., (1998) Flumazenil for hepatic encephalopathy grade III and IV in patients with cirrhosis— An Italian multicenter double-blind, placebo-controlled, cross-over study. Hepatology 28:374–380PubMedCrossRefGoogle Scholar
  2. Basile AS, Hughes RD, Harrison PM, et al., (1991) Elevated brain concentrations of 1,4-benzodiazepine in fulminant hepatic failure. N Engl J Med 1991; 325:473–478CrossRefGoogle Scholar
  3. Bianchi GP, Marchesi G, Fabbri A, et al., (1993) Vegetable versus animal protein diet in cirrhotic patients with chronic encephalopathy. A randomized cross-over comparison. J Intern Med 233:385–392PubMedCrossRefGoogle Scholar
  4. Blanc P, Daures JP, Rouillon JM, et al., (1992) Lactitol or lactulose in the treatment of chronic hepatic encephalopathy: results of a meta-analysis. Hepatology 15:222–227PubMedCrossRefGoogle Scholar
  5. Butterworth RF (1995) Hepatic encephalopathy. Neurologist 1:95–104Google Scholar
  6. Candranel JF, El Younsi M, Pidoux B, et al., (1995) Flumazenil therapy for hepatic encephalopathy in cirrhotic patients: a doubleblind pragmatic randomized, placebo study. Eur J Gastroenterol Hepatol 7:325–329Google Scholar
  7. Casado M, Bosch J, García-Pagán J-C, et al., (1998) Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 114:1296–1303PubMedCrossRefGoogle Scholar
  8. Charlton MR (1996) Branched chains revisited. Gastroenterology 111:252–255PubMedCrossRefGoogle Scholar
  9. Conn HO, Leevy CM, Vlahcevic ZR, et al., (1977) Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy: a double blind controlled trial. Gastroenterology 72:573–583PubMedGoogle Scholar
  10. Ferenci P (1998) Therapie der akuten und chronischen hepatischen Enzephalopathie bei Patienten mit Leberzirrhose. Z Gastroenterol 36:909–916PubMedGoogle Scholar
  11. Gyr K, Meier R, Haussier J, et al., (1996) Evaluation of the efficacy and safety of flumazenil in the treatment of portal systemic encephalo-pathy: a double blind, randomized, placebo controlled multicentre study. Gut 39:319–324PubMedCrossRefGoogle Scholar
  12. Häussinger D, Laubenberger J, vom Dahl S, et al., (1994) Proton magnetic resonance spectroscopy studies on human brain myoinositol in hypo-osmolarity and hepatic encephalopathy. Gastroenterology 107:1475–1480PubMedGoogle Scholar
  13. Häussinger D, Maier K-P (Hrsg) (1996) Hepatische Enzephalopathie. Thieme, StuttgartGoogle Scholar
  14. Holstege A, Lock G, Köllinger M, Schölmerich J (1996) Conservative treatment of acute hepatic failure. Z Gastroenterol 34:192–201PubMedGoogle Scholar
  15. Kircheis G, Nilius R, Held C, et al., (1997) Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy. Results of a placebocontrolled, double-blind study. Hepatology 25:1351–1360PubMedCrossRefGoogle Scholar
  16. Koch H, Schauder P, Schäfer G, et al., (1990) Untersuchungen zur Diagnose und Prävalenz der latenten hepatischen Encephalopathie. Z Gastroenterol 28:610–615PubMedGoogle Scholar
  17. Köllinger M, Kullmann F, Holstege A, Schölmerich J(1996) Prophylaxe und Therapie von Komplikationen der Leberzirrhose: Aszites, Enzephalopathie und Malnutrition. Med Klin 91:89–102Google Scholar
  18. Kuhlbusch R, Enck P, Häussinger D (1998) Hepatische Enzephalopathie: Neurologische und neurophysiologische Diagnostik. Z Gastroenterol 36:1075–1083PubMedGoogle Scholar
  19. Lee W M (1993) Acute liver failure. N Engl J Med 329:1862–1872PubMedCrossRefGoogle Scholar
  20. Lee W M (1995) Drug-induced hepatotoxicity. N Engl J Med 333:1118–1127PubMedCrossRefGoogle Scholar
  21. Morgan MY, Hawley KE (1987) Lactitol vs lactulose in the treatment of acute hepatic encephalopathy in cirrhotic patients: a double blind, randomized trial. Hepatology 7:1278–1284PubMedCrossRefGoogle Scholar
  22. Naylor CD, O’Rorke K, Detsky AS, Baker JP (1989) Parenteral nutrition with branchedchain amino acids in hepatic encephalopathy. A meta-analysis. Gastroenterology 97:1033–1042PubMedGoogle Scholar
  23. Pomier-Layrargues G, Giguére JF, Lavoie J, et al., (1994) Flumazenil in cirrhotic patients in hepatic coma: a randomized double-blind placebo-controlled crossover trial. Hepatology 19:32–37PubMedGoogle Scholar
  24. Record CO (1991) Neurochemistry of hepatic encephalopathy. Gut 32:1261–1263PubMedCrossRefGoogle Scholar
  25. Riggio O, Balducci G, Ariosta F, et al., (1990) Lactitol in the treatment of chronic hepatic encephalopathy: a randomized cross-over comparison with lactulose. Hepatogastroenterology 37:524–527PubMedGoogle Scholar
  26. Riggio O, Ariosto F, Merli M, et al., (1991) Shortterm oral zinc supplementation does not improve chronic hepatic encephalopathy. Results of a double-blind cross-over trial. Dig Dis Sci 36:1204–1208PubMedCrossRefGoogle Scholar
  27. Riordan SM, Willimas R (1997) Treatment of hepatic encephalopathy. N Engl J Med 337:473–479PubMedCrossRefGoogle Scholar
  28. Stauch S, Kircheis G, Adler G, et al., (1998) Oral L-ornithine L-aspartate therapy of chronic hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol 28:856PubMedCrossRefGoogle Scholar
  29. Steindl PE, Finn B, Bendok B, et al., (1995) Disruption of the diurnal rhythm of plasma melatonin in cirrhosis. Ann Intern Med 123:274–278PubMedGoogle Scholar
  30. Watanabe A, Sakai T, Sato S, et al., (1998) Clinical efficacy of lactulose in cirrhotic patients with and without subclinical hepatic encephalopathy. Hepatology 26:1410–1414CrossRefGoogle Scholar
  31. Wilkinson SP (1997) GABA, benzodiazepines and hepatic encephalopathy. Eur J Gastroenterol Hepatol 7:323–324Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • W. F. Caspary

There are no affiliations available

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