Current concepts in the assessment and treatment of Hepatic Encephalopathy

Abstract

Hepatic encephalopathy (HE) is defined as a metabolically induced, potentially reversible, functional disturbance of the brain that may occur in acute or chronic liver disease. Standardized nomenclature has been proposed but a standardized approach to the treatment, particularly of persistent, episodic and recurrent encephalopathy associated with liver cirrhosis has not been proposed. This review focuses on the pathogenesis and treatment of HE in patients with cirrhosis. The pathogenesis and treatment of hepatic encephalopathy in fulminant hepatic failure is quite different and is reviewed elsewhere.

Bile Acid Signaling Is Involved in the Neurological Decline in a Murine Model of Acute Liver Failure

“…34 Currently, HE has few effective treatments and thus the need to identify targets for potential therapeutics is important. Herein, we demonstrate the following: i) bile acid content in the frontal cortex is increased during acute liver failure, ii) strategies to modulate the bile acid content in the brain alter the neurological decline observed, and iii) FXR-mediated signaling contributes to the neurological impairment.…”

Особливості Діагностики Енцефалопатії У Хворих З синдромом Портальної Гіпертензії

“…Золотим стандартом є критерії West Haven [7], що оцінюють п'ять елементів: психічний стан; наявність та інтенсивність астериксису; час, який потрібен для виконання тестів інтелектуального функ-ціонування (наприклад, тест зв'язку чисел); рівень амі-аку у венозній крові; відхилення за даними енцефало-графії (табл. 1).…”

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

“…In addition to grades, HE is classified into one of the following three types: type A (acute liver failure), HE associated with acute liver failure; type B (shunt), HE associated with portosystemic shunt without distinct hepatocellular disease; and type C (cirrhosis), associated with cirrhosis, which is accompanied by portal hypertension or portosystemic shunts [2,3]. The pattern of chronic HE (type B and type C) can be further subdivided into episodic or persistent encephalopathy.…”

“…In type C HE, HE is frequently induced or aggravated by secondary predisposing factors [3]. Thus, correction of these secondary factors, including excessive nitrogen load, electrolyte and metabolic disturbances, drugs and medications, and opportunistic infections, is the basis of treatment.…”