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Semin Liver Dis 2008; 28(1): 070-080
DOI: 10.1055/s-2008-1040322
© Thieme Medical Publishers

Hepatic Encephalopathy

Juan Córdoba1 , Beatriz Mínguez1
  • 1Servei de Medicina Interna-Hepatologia, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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Publication History

Publication Date:
22 February 2008 (online)

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ABSTRACT

Hepatic encephalopathy is a severe complication of cirrhosis that is related to the effects of ammonia. Analysis of interorgan ammonia trafficking has identified an important role of skeletal muscle in ammonia removal and has highlighted the importance of the nutritional status. Ammonia causes neurotransmitter abnormalities and induces injury to astrocytes that is partially mediated by oxidative stress. These disturbances lead to astrocyte swelling and brain edema, which appear to be involved in the pathogenesis of neurological manifestations. Inflammatory mediators worsen brain disturbances. New methods for assessing hepatic encephalopathy include clinical scales, neuropsychological tests, imaging of portal-systemic circulation, and magnetic resonance of the brain. Reappraisal of current therapy indicates the need for performing placebo-controlled trials and the lack of evidence for administering diets with restricted protein content. Liver transplant should be considered in selected patients with hepatic encephalopathy. Future prospects include new drugs that decrease plasma ammonia, measures to reduce brain edema, and liver-support devices.

KEYWORDS

Hepatic encephalopathy - ammonia - pathogenesis - diagnostic methods - therapy

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Juan CórdobaM.D. 

Servei de Medicina Interna-Hepatologia, Hospital Vall d'Hebron

Paseo Vall d'Hebron 119, Barcelona 08035, Spain

Email: jcordoba@vhebron.net