Hepatic encephalopathy
Por:
D. HAUSSINGER, R. DHIMAN, V. FELIPO, B. GORG, R. JALAN, G. KIRCHEIS, M. MERLI, S. MONTAGNESE, M. ROMERO-GOMEZ, A. SCHNITZLER, S. TAYLOR-ROBINSON and H. VILSTRUP
Publicada:
23 jun 2022
Resumen:
Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with liver disease. This Primer discusses the epidemiology, pathophysiology, diagnosis and treatment of hepatic encephalopathy, and discusses how this disorder affects the quality of life of patients.
Hepatic encephalopathy (HE) is a prognostically relevant neuropsychiatric syndrome that occurs in the course of acute or chronic liver disease. Besides ascites and variceal bleeding, it is the most serious complication of decompensated liver cirrhosis. Ammonia and inflammation are major triggers for the appearance of HE, which in patients with liver cirrhosis involves pathophysiologically low-grade cerebral oedema with oxidative/nitrosative stress, inflammation and disturbances of oscillatory networks in the brain. Severity classification and diagnostic approaches regarding mild forms of HE are still a matter of debate. Current medical treatment predominantly involves lactulose and rifaximin following rigorous treatment of so-called known HE precipitating factors. New treatments based on an improved pathophysiological understanding are emerging.
Filiaciones:
D. HAUSSINGER:
Heinrich Heine Univ Dusseldorf, Dept Gastroenterol Hepatol & Infect Dis, Med Fac, Dusseldorf, Germany
Heinrich Heine Univ Dusseldorf, Univ Hosp Dusseldorf, Dusseldorf, Germany
R. DHIMAN:
Sanjay Gandhi Postgrad Inst Med Sci, Dept Hepatol, Lucknow, Uttar Pradesh, India
:
Ctr Invest Principe Felipe, Lab Neurobiol, Valencia, Spain
B. GORG:
Heinrich Heine Univ Dusseldorf, Dept Gastroenterol Hepatol & Infect Dis, Med Fac, Dusseldorf, Germany
Heinrich Heine Univ Dusseldorf, Univ Hosp Dusseldorf, Dusseldorf, Germany
R. JALAN:
UCL Med Sch, Div Med, Liver Failure Grp ILDH, Royal Free Campus, London, England
European Fdn Study Chron Liver Failure, Barcelona, Spain
G. KIRCHEIS:
Univ Hosp Brandenburg, Brandenburg Med Sch, Dept Gastroenterol Diabetol & Hepatol, Brandenburg, Germany
M. MERLI:
Univ Roma Sapienza, Dept Translat & Precis Med, Rome, Italy
S. MONTAGNESE:
Univ Padua, Dept Med, Padua, Italy
M. ROMERO-GOMEZ:
Univ Seville, Virgen Rocio Univ Hosp, Inst Biomed Seville HUVR, UCM Digest Dis,HUVR,CSIC,US, Seville, Spain
A. SCHNITZLER:
Heinrich Heine Univ Dusseldorf, Inst Clin Neurosci & Med Psychol, Dusseldorf, Germany
S. TAYLOR-ROBINSON:
Imperial Coll London, Dept Surg & Canc, St Marys Hosp Campus, London, England
H. VILSTRUP:
Aarhus Univ Hosp, Dept Hepatol & Gastroenterol, Aarhus, Denmark
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