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hepatic encephalopathy diagnos*

Sanath Allampati, Kevin D Mullen
Hepatic Encephalopathy (HE) is a complex neuropsychiatric syndrome associated with decompensated liver disease. The spectrum of disease ranges from trivial abnormalities in complex decision making and prolonged reaction time to coma in its most severe form1. The very initial stages, recently termed covert Hepatic Encephalopathy (CHE), can only be diagnosed with the help of neuropsychiatric testing while the later and more severe forms, termed overt Hepatic Encephalopathy (OHE), can be diagnosed clinically. Severity of HE is graded based on West Haven Criteria and please refer to table 1 for more details2...
October 20, 2016: Minerva Gastroenterologica e Dietologica
Marta Hernández Conde, Elba Llop Herrera, Juan de la Revilla Negro, Fernando Pons Renedo, Natalia Fernández Puga, José Luis Martínez Porras, María Trapero Marugan, Valentín Cuervas-Mons, Víctor Sánchez Turrión, José Luis Calleja Panero
INTRODUCTION: The prevalence of portal vein thrombosis (PVT) in patients that have undergone liver transplantation (LT) is 9.7% (SD 4.5). The aim of our study was to determine the prevalence, assess the factors that are associated with PVT and clarify their association with prognosis in patients with liver cirrhosis (LC) and LT. AIMS AND METHODS: From 2005 to 2014, laboratory, radiological and surgical data were collected from patients with LC in our center who had undergone LT for the first time...
October 19, 2016: Revista Española de Enfermedades Digestivas
Raquel Núñez-Ramos, Soledad Montoro, Marcello Bellusci, María Rosa Del Fresno-Valencia, Marta Germán-Díaz, Pedro Urruzuno, Enrique Medina, Javier Manzanares
PURPOSE: The aims of this study were to analyze the characteristics of patients with acute liver failure (ALF) in our center and evaluate the prognostic value of the Pediatric End-Stage Liver Disease (PELD) score calculated at admission. PATIENTS AND METHODS: A retrospective analysis of patients with ALF younger than 15 years between 2005 and 2013 was performed. Information collected included age, sex, etiology of ALF, laboratory tests, PELD score, stage of encephalopathy, and need for liver support devices such as MARS and/or liver transplant (LT) and survival...
September 30, 2016: Pediatric Emergency Care
Ruby Upadhyay, Thomas P Bleck, Katharina M Busl
Purpose. A 66-year-old man who presented with coma was found to have isolated severe hyperammonemia and diagnosed with a late-onset urea-cycle disorder. He was treated successfully and had full recovery. Methods. We report a novel case of noncirrhotic hyperammonemia and review the literature on this topic. Selected literature for review included English-language articles concerning hyperammonemia using the search terms "hyperammonemic encephalopathy", "non-cirrhotic encephalopathy", "hepatic encephalopathy", "urea-cycle disorders", "ornithine transcarbamylase (OTC) deficiency", and "fulminant hepatic failure"...
2016: Case Reports in Medicine
Yasir Furkan Cagin, Yahya Atayan, Mehmet Ali Erdogan, Firat Dagtekin, Cemil Colak
BACKGROUND: Portal vein thrombosis (PVT) is due to many risk factors, but its pathogenesis is still not clearly understood. To identify the risk factors for PVT, we analyzed the clinical characteristics and complications associated with PVT in cirrhotic patients. METHODS: We studied patients with liver cirrhosis who were admitted to our unit from April 2009 to December 2014. The patients were divided into the PVT and non-PVT groups, and were compared by variables including gender, age, the etiology of cirrhosis, stage of cirrhosis, complications, imaging, and treatment...
October 2016: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Ying Li, Huaijun Liu, Jiping Yang, Xin Tian, Haiqing Yang, Zuojun Geng
AIM: Our objective is to explore key changes in brain functions in relation to minimal hepatic encephalopathy (MHE). Moreover, we incorporated both resting-state functional MRI (fMRI) and arterial spin labeling (ASL) to enhance the detection of MHE. METHODS: We conducted fMRI scanning for 56 MHE patients and 66 healthy controls. Region functional connectivity (FC) was carried out to assess the connectivity status between pair of regions among 90 brain regions. Additionally, blood flood (BF) status was measured by ASL for all subjects...
October 7, 2016: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Lea Ladegaard Grønkjær, Palle Holmstrup, Søren Schou, Kristoffer Schwartz, Johanne Kongstad, Peter Jepsen, Hendrik Vilstrup
BACKGROUND: Periapical radiolucency is the radiographic sign of inflammatory bone lesions around the apex of the tooth. We determined the prevalence and predictors of periapical radiolucency in patients with cirrhosis and the association with systemic inflammation status and cirrhosis-related complications. METHODS: A total of 110 cirrhosis patients were consecutively enrolled. Periapical radiolucency was defined as the presence of radiolucency or widening of the periapical periodontal ligament space to more than twice the normal width...
2016: Hepatic Medicine: Evidence and Research
Mariangela Giunta, Dario Conte, Mirella Fraquelli
The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices...
September 21, 2016: World Journal of Gastroenterology: WJG
Liane Rabinowich, Julia Wendon, William Bernal, Oren Shibolet
AIM: To assess the practice of caring for acute liver failure (ALF) patients in varying geographic locations and medical centers. METHODS: Members of the European Acute Liver Failure Consortium completed an 88-item questionnaire detailing management of ALF. Responses from 22 transplantation centers in 11 countries were analyzed, treating between 300 and 500 ALF cases and performing over 100 liver transplants (LT) for ALF annually. The questions pertained to details of the institution and their clinical activity, standards of care, referral and admission, ward- based care versus intensive care unit (ICU) as well as questions regarding liver transplantation - including criteria, limitations, and perceived performance...
September 7, 2016: World Journal of Gastroenterology: WJG
Narendra Choudhary, Rinkesh Kumar Bansal, Rajesh Puri, Rajiv Ranjan Singh, Mukesh Nasa, Vinit Shah, Haimanti Sarin, Mridula Guleria, Sanjiv Saigal, Neeraj Saraf, Randhir Sud, Arvinder S Soin
BACKGROUND AND AIMS: Etiologic diagnosis of pyrexia of unknown origin is important in patients with cirrhosis for optimal management and to prevent flare up of infectious disease after liver transplantation. However, there is very limited literature available on this subject. The present study aimed to examine the safety and impact of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in patients with cirrhosis. METHODS: The study was conducted between January 2014 and January 2016 at a tertiary care center...
September 2016: Endoscopy International Open
Seiichiro Kojima, Hiroyuki Ito, Shinji Takashimizu, Hitoshi Ichikawa, Tomohiro Matsumoto, Terumitsu Hasebe, Norihito Watanabe
A 64-year-old woman treated for anemia and ascites exhibited hepatic encephalopathy. Abdominal ultrasonography and computed tomography (CT) showed communication between the portal vein and the middle hepatic vein, indicating an intrahepatic portosystemic venous shunt (PSS). Since hepatic encephalopathy of the patient was resistant to medical treatment, interventional radiology was performed for the treatment of shunt obliteration. Hepatic venography showed anastomosis between the hepatic vein branches, supporting the diagnosis of idiopathic portal hypertension (IPH)...
September 2016: Acta Radiologica Open
Wissam K Kabbara, Aline T Sarkis, Paola G Saroufim
This paper describes a case of an acute and fatal isoniazid-induced hepatotoxicity and provides a review of the literature. A 65-year-old female diagnosed with latent Mycobacterium tuberculosis infection was receiving oral isoniazid 300 mg daily. She was admitted to the hospital for epigastric and right sided flank pain of one-week duration. Laboratory results and imaging confirmed hepatitis. After ruling out all other possible causes, she was diagnosed with isoniazid-induced acute hepatitis (probable association by the Naranjo scale)...
2016: Case Reports in Infectious Diseases
Julie C Fitzgerald, Scott L Weiss, Shannon L Maude, David M Barrett, Simon F Lacey, J Joseph Melenhorst, Pamela Shaw, Robert A Berg, Carl H June, David L Porter, Noelle V Frey, Stephan A Grupp, David T Teachey
OBJECTIVE: Initial success with chimeric antigen receptor-modified T cell therapy for relapsed/refractory acute lymphoblastic leukemia is leading to expanded use through multicenter trials. Cytokine release syndrome, the most severe toxicity, presents a novel critical illness syndrome with limited data regarding diagnosis, prognosis, and therapy. We sought to characterize the timing, severity, and intensive care management of cytokine release syndrome after chimeric antigen receptor-modified T cell therapy...
September 14, 2016: Critical Care Medicine
Jiří Ehrmann, Květa Aiglová, Michal Konečný, Vlastimil Procházka, Drahomíra Vrzalová
UNLABELLED: There are 40 000-60 000 patients with cirrhosis in the Czech Republic. 2 000 die of this disease yearly. This group of patients needs a complex treatment and it is mostly an internist cooperating with other specialists. The most important for an ambulant internist is to diagnose the disease as soon as possible and start with treatment of chronic liver disease that could lead to a cirrhosis. It means especially chronic viral hepatitis, alcoholic or non-alcoholic steatosis/steatohepatitis, auto-immune liver damage and metabolic disease...
2016: Vnitr̆ní Lékar̆ství
Ali Al Balushi, Marshall W Meeks, Ghazala Hayat, Jafar Kafaie
BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive neurodegenerative disease that almost always results in death in under a year from onset of symptoms. Here, we report four cases of CJD with different clinical presentations diagnosed at our institution over a 2-year period. CASES: The first patient is an 82-year-old woman who presented with depression, cognitive decline, and word-finding difficulty over 4 weeks. The patient deteriorated neurologically to akinetic mutism and death within 6 weeks of presentation...
2016: Frontiers in Neurology
N S Mittelman, J B Engiles, L Murphy, D Vudathala, A L Johnson
An 8-year-old Holsteiner gelding was presented for evaluation of anorexia, obtundation, icterus, and mild colic signs of 48 hours duration. History, physical examination, and initial diagnostics were suggestive of hepatic disease and encephalopathy. Microcystin toxicosis was suspected based on historical administration of a cyanobacteria supplement, associated serum biochemistry abnormalities, and characteristic histopathological changes. Microcystin contamination was confirmed in both supplement containers fed to the horse...
September 2016: Journal of Veterinary Internal Medicine
Iris Völker, Iris Schwarze, Tina E Brezina, Saskia Köstlinger, Marion Hewicker-Trautwein
An 8-month-old, male African hedgehog clinically displayed a wobbly walk, anuria, inappetence and apathy, whereupon the suspected diagnosis wobbly hedgehog syndrome was made. After exacerbation, the hedgehog was euthanized. Histologically, a tumour mainly consisting of medium-sized, oval tumour cells and a smaller number of spindeloid cells was found in the cerebrum. The tumour contained neuropil islets and extracellular myxoid material. Immunohistochemically, the tumour cells expressed oligodendroglial (neurite outgrowth inhibitor, Nogo-A; oligodendrocyte transcription factor, Olig-2) and neuronal (neuron-specific enolase, NSE; microtubule-associated protein-2a, MAP-2a; synaptophysin) cell markers...
October 12, 2016: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
Nasser Mousa, Ahmed Abdel-Razik, Ashraf Zaher, Magdy Hamed, Gamal Shiha, Narmin Effat, Sherif Elbaz, Rania Elhelaly, Mohamed Hafez, Niveen El-Wakeel, Waleed Eldars
BACKGROUND: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. METHODS: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs)...
September 2016: Therapeutic Advances in Gastroenterology
Fernando Mendes Paschoal, Ricardo Carvalho Nogueira, Karla De Almeida Lins Ronconi, Marcelo de Lima Oliveira, Manoel Jacobsen Teixeira, Edson Bor-Seng-Shu
Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation...
August 8, 2016: World Journal of Hepatology
Javier Fernández, Juan Acevedo, Verónica Prado, Mario Mercado, Miriam Castro, Marco Pavesi, Mireya Arteaga, Lydia Sastre, Adria Juanola, Pere Ginès, Vicente Arroyo
: Clinical course and risk factors of death in non-SBP infections are poorly known. We assessed the prevalence of AKI and type-1 HRS, hospital, 30-d and 90-d mortality and risk factors of death in 441 decompensated patients. METHODS: Analysis of 615 non-SBP infections (161 urinary infections, 95 cellulitis, 92 suspected infections, 92 bacteremias, 84 pneumonias, 21 bronchitis, 18 cholangitis, 15 spontaneous empyema, 13 secondary peritonitis, 24 other). RESULTS: 96% of infections solved...
August 25, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
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