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Hepatic encephalopathy

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https://www.readbyqxmd.com/read/28813200/brain-microstructural-abnormalities-in-patients-with-cirrhosis-without-overt-hepatic-encephalopathy-a-voxel-based-diffusion-kurtosis-imaging-study
#1
Hua-Jun Chen, Peng-Fei Liu, Qiu-Feng Chen, Hai-Bin Shi
OBJECTIVE: This study aimed to investigate whole-brain microstructural abnormalities and their correlation with cognitive impairment in patients with cirrhosis using diffusion kurtosis imaging (DKI). SUBJECTS AND METHODS: Eighteen patients with cirrhosis and 17 healthy control subjects underwent DKI. Cognition was measured using psychometric hepatic encephalopathy (HE) scores. Whole-brain voxel-based analyses were performed to investigate between-group differences in DKI-derived parameters, including mean kurtosis, axial kurtosis, and radial kurtosis...
August 16, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28811719/refractory-hepatic-encephalopathy-in-a-patient-with-hypothyroidism-another-element-in-ammonia-metabolism
#2
Fernando Díaz-Fontenla, Marta Castillo-Pradillo, Arantxa Díaz-Gómez, Luis Ibañez-Samaniego, Pilar Gancedo, Juan Adan Guzmán-de-Villoria, Pilar Fernández-García, Rafael Bañares-Cañizares, Rita García-Martínez
Hepatic encephalopathy (HE) remains a diagnosis of exclusion due to the lack of specific signs and symptoms. Refractory HE is an uncommon but serious condition that requires the search of hidden precipitating events (i.e., portosystemic shunt) and alternative diagnosis. Hypothyroidism shares clinical manifestations with HE and is usually considered within the differential diagnosis of HE. Here, we describe a patient with refractory HE who presented a large portosystemic shunt and post-ablative hypothyroidism...
July 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28805273/neurotoxicosis-in-horses-associated-with-consumption-of-trema-micrantha
#3
M P Lorenzett, P R Pereira, D M Bassuino, G Konradt, W Panziera, M V Bianchi, F F Argenta, M E Hammerschmitt, R A Caprioli, C S L de Barros, S P Pavarini, D Driemeier
BACKGROUND: Trema micrantha is a tree widely distributed throughout the Americas. The tree produces highly palatable leaves that have been associated with natural poisoning in goats, sheep and horses, in which hepatic necrosis and hepatic encephalopathy have been observed. OBJECTIVES: This study describes malacia and haemorrhage in the central nervous system due to T. micrantha consumption, with minimal to absent hepatic lesions. STUDY DESIGN: Retrospective case series...
August 14, 2017: Equine Veterinary Journal
https://www.readbyqxmd.com/read/28801579/tnf%C3%AE-induced-up-regulation-of-na-k-2cl-cotransporter-nkcc1-in-hepatic-ammonia-clearance-and-cerebral-ammonia-toxicity
#4
Vitaly I Pozdeev, Elisabeth Lang, Boris Görg, Hans J Bidmon, Prashant V Shinde, Gerald Kircheis, Diran Herebian, Klaus Pfeffer, Florian Lang, Dieter Häussinger, Karl S Lang, Philipp A Lang
The devastating consequences of hepatic failure include hepatic encephalopathy, a severe, life threatening impairment of neuronal function. Hepatic encephalopathy is caused by impaired hepatic clearance of NH4(+). Cellular NH4(+) uptake is accomplished mainly by the Na(+),K(+),2Cl(-) cotransporter. Here we show that hepatic clearance of NH4(+) is impaired in TNFα deficient as well as TNFR1&TNFR2 double knockout mice, which both develop hyperammonemia. Despite impaired hepatic clearance of NH4(+), TNFα deficient mice and TNFR1 deficient mice were protected against acute ammonia intoxication...
August 11, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28799305/comparison-of-rifaximin-plus-lactulose-with-the-lactulose-alone-for-the-treatment-of-hepatic-encephalopathy
#5
Kiran Ahire, Archana Sonawale
INTRODUCTION: Hepatic encephalopathy is challenging complication of liver dysfunction. Therapeutic treatment options for hepatic encephalopathy are currently limited and have appreciable risks and benefits associated with their use. Rifaximin is a novel anti microbiological agent with wide spectrum of activity that has shown promise as an alternative option for hepatic encephalopathy. AIMS AND OBJECTIVE: The present study was undertaken to compare the effectiveness of Rifaximin and Lactulose as a combination vs Lactulose alone, to compare the adverse effects and to study the rapidity of therapeutic effects of Rifaximin and Lactulose...
August 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28796283/flumazenil-versus-placebo-or-no-intervention-for-people-with-cirrhosis-and-hepatic-encephalopathy
#6
REVIEW
Ee Teng Goh, Mette L Andersen, Marsha Y Morgan, Lise Lotte Gluud
BACKGROUND: Hepatic encephalopathy is a common complication of cirrhosis which results in poor brain functioning. The spectrum of changes associated with hepatic encephalopathy ranges from the clinically 'indiscernible' or minimal hepatic encephalopathy to the clinically 'obvious' or overt hepatic encephalopathy. Flumazenil is a synthetic benzodiazepine antagonist with high affinity for the central benzodiazepine recognition site. Flumazenil may benefit people with hepatic encephalopathy through an indirect negative allosteric modulatory effect on gamma-aminobutyric acid receptor function...
August 10, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28796076/factors-affecting-mortality-and-resource-use-for-hospitalized-patients-with-cirrhosis-a-population-based-study
#7
Phunchai Charatcharoenwitthaya, Ngamphol Soonthornworasiri, Khemajira Karaketklang, Kittiyod Poovorawan, Wirichada Pan-Ngum, Watcharasak Chotiyaputta, Tawesak Tanwandee, Kamthorn Phaosawasdi
Hospitalizations for advanced liver disease are costly and associated with significant mortality. This population-based study aimed to evaluate factors associated with in-hospital mortality and resource use for the management of hospitalized patients with cirrhosis.Mortality records and resource utilization for 52,027 patients hospitalized with cirrhosis and/or complications of portal hypertension (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or hepatorenal syndrome) were extracted from a nationally representative sample of Thai inpatients covered by Universal Coverage Scheme during 2009 to 2013...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28795995/toxic-myocarditis-caused-by-acetaminophen-in-a-multidrug-overdose
#8
Maxime Gosselin, Yann Dazé, Pascal Mireault, Marie Crahes
We report the case of an 18-year-old woman with personality disorders who was hospitalized a few hours after suicidal ingestion of acetaminophen, quetiapine, acetylsalicylic acid, and ethanol. Twelve hours after admission, severe liver damage was evident, but the patient was stable and awaiting hepatic transplantation. Electrolytes were successfully controlled. The condition of the liver stabilized. Cardiac biomarkers then deteriorated unexpectedly. Localized ST-segment elevations were noted on electrocardiogram, but angiography ruled out myocardial infarction...
August 9, 2017: American Journal of Forensic Medicine and Pathology
https://www.readbyqxmd.com/read/28792999/clinical-features-of-refractory-ascites-in-outpatients
#9
Wanda Regina Caly, Rodrigo Martins Abreu, Bernardo Bitelman, Flair José Carrilho, Suzane Kioko Ono
OBJECTIVES: To present the clinical features and outcomes of outpatients who suffer from refractory ascites. METHODS: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month...
July 2017: Clinics
https://www.readbyqxmd.com/read/28792650/oral-oxycodone-naloxone-for-pain-control-in-liver-cirrhosis-observational-study-in-patients-with-symptomatic-metastatic-hepatocellular-carcinoma
#10
Francesco Tovoli, Stefania De Lorenzo, Boaz Gedaliahu Samolsky Dekel, Fabio Piscaglia, Francesca Benevento, Giovanni Brandi, Luigi Bolondi
BACKGROUND & AIMS: Pain management in liver cirrhosis is a clinical challenge. Most analgesics are metabolized in the liver and cirrhosis may deeply alter their concentration, favoring the appearance of side effects. We aimed to assess the efficacy and safety of oral prolonged-release association of oxycodone/naloxone tablets (OXN) in the treatment of moderate/severe cancer pain in cirrhotic patients with metastatic hepatocellular carcinoma (HCC). METHODS: We enrolled n=32 HCC patients with moderate/severe cancer pain unresponsive to paracetamol alone or associated with codeine or tramadol...
August 9, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28791885/shunt-preserving-disconnection-of-the-portal-to-systemic-circulation-in-patients-with-hepatic-encephalopathy
#11
Osamu Ikeda, Seijiro Inoue, Yoshitaka Tamura, Yo-Ichi Yamashita, Hideo Baba, Yukihiro Inomata, Yasuyuki Yamashita
Background Portosystemic shunt obliteration by surgical or interventional radiological techniques can be effective for patients with hepatic encephalopathy (HE) although this approach is often associated with accumulation of ascites and/or formation of esophageal varices. Purpose To evaluate the clinical efficacy and safety of shunt-preserving disconnection of the portosystemic circulation (SPDPS) in patients with HE. Material and Methods Nine patients with HE and a splenorenal shunt were treated by SPDPS: eight underwent selective coil embolization of the splenic vein and one underwent stent-graft closure of the shunt...
January 1, 2017: Acta Radiologica
https://www.readbyqxmd.com/read/28791561/electro-radiological-observations-of-grade-iii-iv-hepatic-encephalopathy-patients-with-seizures
#12
Christopher R Newey, Pravin George, Aarti Sarwal, Norman So, Stephen Hantus
BACKGROUND: Neurological complications in liver failure are common. Often under-recognized neurological complications are seizures and status epilepticus. These may go unrecognized without continuous electroencephalography (CEEG). We highlight the observed electro-radiological changes in patients with grade III/IV hepatic encephalopathy (HE) found to have seizures and/or status epilepticus on CEEG and the associated neuroimaging. METHODS: This study was a retrospective review of patients with West Haven grade III/IV HE and seizures/status epilepticus on CEEG...
August 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28782153/n-acetylcysteine-and-prednisolone-treatment-improved-serum-biochemistries-in-suspected-flupirtine-cases-of-severe-idiosyncratic-liver-injury
#13
Jürgen Borlak, Florian van Bömmel, Thomas Berg
BACKGROUND & AIMS: The analgesic flupirtine has been linked to cases of severe idiosyncratic drug-induced liver injury (sFILI). We therefore examined whether N-acetylcysteine (NAC) and glucocorticoid therapy is effective in the management of sFILI. METHODS: In a retrospective cohort study efficacy of NAC-infusion and oral prednisolone treatments on liver-function-tests (LFTs) and clinical outcome of 21 sFILI cases was evaluated by comparing it to an external cohort of 30 sFILI cases not receiving the antidote...
August 7, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28776344/validation-of-a-paper-and-pencil-test-battery-for-the-diagnosis-of-minimal-hepatic-encephalopathy-in-korea
#14
Jae Yoon Jeong, Dae Won Jun, Daiseg Bai, Ji Yean Kim, Joo Hyun Sohn, Sang Bong Ahn, Sang Gyune Kim, Tae Yeob Kim, Hyoung Su Kim, Soung Won Jeong, Yong Kyun Cho, Do Seon Song, Hee Yeon Kim, Young Kul Jung, Eileen L Yoon
The aim of this study was to validate a new paper and pencil test battery to diagnose minimal hepatic encephalopathy (MHE) in Korea. A new paper and pencil test battery was composed of number connection test-A (NCT-A), number connection test-B (NCT-B), digit span test (DST), and symbol digit modality test (SDMT). The norm of the new test was based on 315 healthy individuals between the ages of 20 and 70 years old. Another 63 healthy subjects (n = 31) and cirrhosis patients (n = 32) were included as a validation cohort...
September 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/28770516/hepatic-encephalopathy-a-critical-current-review
#15
REVIEW
Anna Hadjihambi, Natalia Arias, Mohammed Sheikh, Rajiv Jalan
Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of cirrhosis and/or porto-systemic shunting. The clinical symptoms are widely variable, extending from subtle impairment in mental state to coma. The utility of categorizing the severity of HE accurately and efficiently serves not only to provide practical functional information about the current clinical status of the patient but also gives valuable prognostic information. In the past 20-30 years, there has been rapid progress in understanding the pathophysiological basis of HE; however, the lack of direct correlation between pathogenic factors and the severity of HE make it difficult to select appropriate therapy for HE patients...
August 2, 2017: Hepatology International
https://www.readbyqxmd.com/read/28770495/fecal-microbiota-transplantation-beyond-clostridium-difficile
#16
REVIEW
Braden Millan, Michael Laffin, Karen Madsen
PURPOSE OF REVIEW: Fecal microbiota transplantation (FMT) has been established as standard of care in the treatment of antibiotic refractory Clostridium difficile infection (RCDI). This review examines the current evidence that exists to support the use of FMT in the treatment of human disease beyond C. difficile infection. RECENT FINDINGS: Beneficial effects of FMT have been described in case series or small prospective trials on a wide spectrum of conditions, including inflammatory bowel disease, functional gastrointestinal disorders, non-alcoholic steatohepatitis, alcoholic hepatitis, hepatic encephalopathy, and neuropsychiatric conditions, and in limiting antibiotic-resistant bacterial infections...
September 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28768371/minimal-hepatic-encephalopathy-identifies-patients-at-risk-of-faster-cirrhosis-progression
#17
Javier Ampuero, Carmina Montoliú, Macarena Simón-Talero, Virginia Aguilera, Raquel Millán, Celina Márquez, Rodrigo Jover, María Carmen Rico, Carmen Sendra, Miguel Ángel Serra, Manuel Romero-Gómez
BACKGROUND &AIM: Minimal hepatic encephalopathy (MHE) predicts poor prognosis and could reflect an advanced liver disease. We aimed to assess whether MHE could be a surrogate marker of a further liver disease. METHODS: Prospective multicenter study including 320 cirrhotic patients, followed for up to 5 years, which were classified at baseline in: compensated cirrhosis without (stage 1) and with varices (stage 2), one decompensating event (stage 3), any second decompensating event (stage 4)...
August 2, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28765699/effect-of-initial-stent-position-on-patency-of-transjugular-intrahepatic-portosystemic-shunt
#18
Shi-Hua Luo, Jian-Guo Chu, He Huang, Ke-Chun Yao
AIM: To evaluate the effect of initial stent position on transjugular intrahepatic portosystemic shunt (TIPS). METHODS: We studied 425 patients from January 2004 to January 2015 with refractory ascites or variceal bleeding who required TIPS placement. Patients were randomly divided into group A (stent in hepatic vein, n = 57), group B (stent extended to junction of hepatic vein and inferior vena cava, n = 136), group C (stent in left branch of portal vein, n = 83) and group D (stent in main portal vein, n = 149)...
July 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28764217/performance-of-disease-specific-scoring-models-in-intensive-care-patients-with-severe-liver-diseases
#19
Maged T El-Ghannam, Moataz H Hassanien, Mohamed D El-Talkawy, Abdel Aziz A Saleem, Amal I Sabry, Hoda M Abu Taleb
INTRODUCTION: Egypt has the highest prevalence of Hepatitis C Virus (HCV) in the world, estimated nationally at 14.7%. HCV treatment consumes 20% ($80 million) of Egypt's annual health budget. Outcomes of cirrhotic patients admitted to the ICU may, in fact, largely depend on differences in the state of the disease, criteria and indications for admission, resource utilization, and intensity of treatment. AIM: The aim of the present study was to evaluate the efficacy of liver specific scoring models in predicting the outcome of critically ill cirrhotic patients in the ICU as it may help in prioritization of high risk patients and preservation of ICU resources...
June 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28763339/long-term-outcomes-of-transjugular-intrahepatic-portosystemic-shunt-in-indian-patients-with-budd-chiari-syndrome
#20
Shalimar, Shivanand R Gamanagatti, Arpan H Patel, Saurabh Kedia, Baibaswata Nayak, Deepak Gunjan, Gyan Ranjan, Shashi B Paul, Subrat K Acharya
BACKGROUND/AIM: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in Budd-Chiari syndrome (BCS) based on current data. Our objective was to evaluate outcomes and assess prognostic factors in BCS patients undergoing TIPS. PATIENTS AND METHODS: In this retrospective analysis of a propectively maintained database, all consecutive BCS patients undergoing TIPS from September 2010 to February 2017 were included. Complete response after TIPS was defined as resolution of symptoms (ascites/pedal edema) with no requirement of diuretics at the end of 4 weeks...
July 31, 2017: European Journal of Gastroenterology & Hepatology
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