Hepatic Coma Due to Liver Metastases

Pal, Nirvik; Whittingham, G. E.; Paley, Ronald G.

doi:10.1136/bmj.1.5428.168

Cited by 12 publications

(2 citation statements)

References 2 publications

(1 reference statement)

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“…Symptoms can range from mild alterations in consciousness or behavior to coma (2). In cancer patients, hepatic encephalopathy is usually the result of abnormality of the portal venous system (3) such as thrombosis (4) or hypertension (5) causing portosystemic shunting, or massive hepatic tumor burden causing global hepatocellular insufficiency (6, 7). These changes may result in the inability of the liver to metabolize many substances including ammonia (8).…”

Section: Introductionmentioning

confidence: 99%

Resolution of Hepatic Encephalopathy Following Hepatic Artery Embolization in a Patient with Well-Differentiated Neuroendocrine Tumor Metastatic to the Liver

Erinjeri

Deodhar

Thornton

et al. 2009

Cardiovasc Intervent Radiol

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Hepatic encephalopathy is considered a contraindication to hepatic artery embolization. We describe a patient with well-differentiated neuroendocrine tumor metastatic to liver with refractory hepatic encephalopathy and normal liver function tests. The encephalopathy was refractory to standard medical therapy with lactulose. The patient’s mental status returned to baseline after 3 hepatic artery embolization procedures. Arteriography and ultrasound imaging before and after embolization suggest that the encephalopathy was due to arterioportal shunting causing hepatofugal portal venous flow and portosystemic shunting. In patients with primary or metastatic well-differentiated neuroendocrine tumor whose refractory hepatic encephalopathy is due to portosystemic shunting (rather than global hepatic dysfunction secondary to tumor burden), hepatic artery embolization can be performed safely and effectively.

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Section: Introductionmentioning

confidence: 99%

Resolution of Hepatic Encephalopathy Following Hepatic Artery Embolization in a Patient with Well-Differentiated Neuroendocrine Tumor Metastatic to the Liver

Erinjeri

Deodhar

Thornton

et al. 2009

Cardiovasc Intervent Radiol

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“…Abnormal liver texture was noted on imaging in less than half the cases described by Rowbotham et al . Massive increases in aminotransferases (up to 100-fold elevated) can occur with malignant infiltration3 4 5 and would help to exclude acute alcoholic hepatitis, which may occasionally be misdiagnosed in this setting 6. Lactic acidosis and a disproportionately raised lactate dehydrogenase are suggestive of haematological malignancy 7.…”

mentioning

confidence: 99%

The failing malignant liver

Smith

James

1998

Gut

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Hepatic encephalopathy and orotic aciduria associated with hepatocellular carcinoma in a noncirrhotic liver

et al. 1988

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A 40-yr-old man presented with encephalopathy and was found to have hepatocellular carcinoma without cirrhosis. A large vascular hepatic mass was defined by CT scan and angiography; laparoscopy with biopsy confirmed the absence of chronic liver disease. A definitive tissue diagnosis of hepatocellular carcinoma was made at laparotomy; the tumor was unresectable. Peripheral arterial and selective portal and hepatic venous ammonia levels were high, and this finding suggested that the encephalopathy was nitrogenous and hepatic in origin. The proposed mechanisms of the encephalopathy are generation of ammonia from tumor breakdown and portosystemic shunting, a result of partial tumor occlusion of the hepatic veins. An unusually high urinary excretion of orotic acid was found similar to that seen in hereditary orotic aciduria.

show abstract

Hepatic Coma Due to Liver Metastases

Cited by 12 publications

References 2 publications

Resolution of Hepatic Encephalopathy Following Hepatic Artery Embolization in a Patient with Well-Differentiated Neuroendocrine Tumor Metastatic to the Liver

Resolution of Hepatic Encephalopathy Following Hepatic Artery Embolization in a Patient with Well-Differentiated Neuroendocrine Tumor Metastatic to the Liver

The failing malignant liver

Hepatic encephalopathy and orotic aciduria associated with hepatocellular carcinoma in a noncirrhotic liver

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