The Management of Hepatic Encephalopathy from Ward to Domiciliary Care: Current Evidence and Gray Areas

Abstract

Hepatic encephalopathy (HE) is a common complication of advanced liver disease and acute liver failure. It is a condition that features several neuropsychiatric symptoms that affect mortality, morbidity and the quality of patients’ and caregivers’ lives. An HE diagnosis is generally an exclusion diagnosis. Once the patient is admitted to the hospital, clinical examination, blood tests and eventually neuroimaging should be performed with the aim of ruling out other causes of acute brain dysfunction. Moreover, HE is recognized using various precipitants that can potentially promote its onset, alone or in combination, and must be identified. Once the diagnostic process is complete, a correct treatment should be started. The anti-HE treatment is based on a combination of the correction of precipitants; non-absorbable antibiotics, such as rifaximin; and non-absorbable disaccharides. Once the patient is discharged from the hospital, specific anti-HE therapy should be maintained in order to prevent other HE episodes.

The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia

“…The identification and correction of IDA have been emphasized as an essential part of comprehensive clinical management for CHF patients [8]. In addition to these findings, recent research has delved deeper into the intricacies of iron deficiency in heart failure in which a study on the nuanced relationship between iron metabolism and the pathophysiology of CHF elucidated that impaired iron homeostasis contributes significantly to the progression of heart failure [9]. This expanding body of evidence strongly supports the inclusion of routine assessment for IDA and targeted iron supplementation as a pivotal component of the holistic management of CHF patients, offering symptomatic relief and potential avenues for improving their overall cardiac function and prognosis.…”