Hepatic encephalopathy: An updated approach from pathogenesis to treatment

Toris, Giannakis T.; Bikis, Christos; Tsourouflis, Gerasimos; Theocharis, Stamatios

doi:10.12659/msm.881387

Cited by 31 publications

(17 citation statements)

References 93 publications

(102 reference statements)

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“…Hepatic function insufficiency and short-circuit of circulation are key causes to the patients with chronic liver disease-induced type C HE, then accumulated toxins will circulate into the brain via the altered BBB and causes encephalopathy by abnormal neurotransmissions. At present, most scholars believe deregulated liver functions and impaired CNS functions can influence each other, resulting in secondary damages to the body [3,37] . Recent study found that increased activity of brain acetylcholinesterase in patients and animals of type C HE would cause the decrease of acetylcholine level.…”

Section: Type C He: Animal Models and Pathogenic Mechanismsmentioning

confidence: 99%

Research progress on hepatic encephalopathy: animal models and disease mechanisms

Xiao

2015

Abdomen

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Hepatic encephalopathy (HE) is a hepatic disease with neuronal confusion, altered level of consciousness, and coma as a result of severe liver damage/failure. HE is with complicated pathological mechanisms and high mortality, which seriously affects patients' daily life. Roughly, it can be divided into three types, A, B and C. Type A is acute HE and Types B and C are chronic. At present, the pathogenesis of HE is still unclear. In addition, there is no specific clinical treatment. Therefore, establishing appropriate HE animal model is vital for the mechanistic study of the disease and the development of clinical therapy. This review makes a summary on the recent progress of HE animal model establishment and current study of its underlying molecular mechanisms.

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Section: Type C He: Animal Models and Pathogenic Mechanismsmentioning

confidence: 99%

Research progress on hepatic encephalopathy: animal models and disease mechanisms

Xiao

2015

Abdomen

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“…It is based on changes of consciousness, intellectual function, behavior, and is useful in monitoring patient progress. Ammonia levels should be measured if HE is suspected and lactulose and systemic antibiotcs prescribed to alter gut flora and reduce the production and absorption of ammonia [80] . A number of risk factors have been identified for the development of post-hepatectomy liver failure and have been summarised in a recent review [81] .…”

Section: Bile Leaksmentioning

confidence: 99%

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Farid

Prasad²,

Morris‐Stiff³

2013

WJGS

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Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients. Core tip: Applied anatomy as used in hepatic surgery is different to the traditional morphological teaching. Applied hepatic anatomy is complex but trainees require an understanding of the basic principles to allow an appreciation of the operations performed. Complications require a low threshold of suspicion as they often have important consequences in relation to patient outcome. Recognition of such with rapid alerting of senior staff can facilitate timely and effective management. To date, no universal protocol exists for management of the post-operative period and varies from centre to centre. We provide a practical overview of the terminology, post-operative management, and complications associated with hepatic surgery.

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“…It is observed in patients with decompensated liver function such as in Cirrhosis and in those with Acute Liver Failure [ALF], in the absence of other known brain disease [1] . HE can be a complication after insertion of a trans-jugular intrahepatic porto-systemic shunt [TIPS] [2] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Serum Ammonia in Hepatic Encephalopathy Patients and Its Correlation with Clinical Severity

Thangasami

Lalchandhani

Mathiyalagan

2016

Journal of Gastroenterology and Hepatology Research

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group were significantly higher than cirrhosis group (q = 10.59, p ≤ 0.001). In all 3 groups, an increase in mean serum ammonia levels were associated with worsening clinical status. Out of 84 patients, 12 patients (14.29%) of cirrhosis group, 18 (21.43%) of acute viral hepatitis group, 4 (4.76%) of drug induced hepatitis expired during the course of illness. A higher risk of mortality was observed with an increase in serum ammonia levels. In cirrhosis group, 100% mortality was found with serum ammonia > 200 µg/dL. In acute viral hepatitis, 70% mortality was observed with serum ammonia levels > 200µg/dL. In drug induced hepatitis, 100% mortality was observed with serum ammonia values > 150 µg/dL. CONCLUSION: An elevated serum ammonia level is an important laboratory abnormality in patients with HE. Both the mortality and severity of HE increases with an increase in serum ammonia levels. This could be useful in identifying patientswith higher grades of HE, suggesting that estimation of serum ammonia could be a useful tool in assessing the severity of illness and to plan for aggressive detoxification measures. ABSTRACT AIM: To study serum ammonia levels and its correlation with clinical status in patients of hepatic encephalopathy.

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Hepatic encephalopathy: An updated approach from pathogenesis to treatment

Cited by 31 publications

References 93 publications

Research progress on hepatic encephalopathy: animal models and disease mechanisms

Research progress on hepatic encephalopathy: animal models and disease mechanisms

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Evaluation of Serum Ammonia in Hepatic Encephalopathy Patients and Its Correlation with Clinical Severity

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