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Hepatic encephalopathy

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https://www.readbyqxmd.com/read/29457869/assessment-of-the-spectrum-of-hepatic-encephalopathy-a-multi-center-study
#1
Bradley Reuter, Kara Walter, Julien Bissonnette, Michael D Leise, Jennifer Lai, Puneeta Tandon, Patrick S Kamath, Scott W Biggins, Christopher F Rose, James B Wade, Jasmohan S Bajaj
Hepatic encephalopathy (HE) is a major cause of morbidity in cirrhosis. However its severity assessment is often subjective, which needs to be studied systematically. AIM: To determine how accurately trainee and non-trainee practitioners grade and manage HE patients throughout its severity. METHODS: We performed a survey study using standardized simulated patient videos at 4 US and 3 Canadian centers. Participants were trainees (gastroenterology/hepatology fellows) and non-trainees (faculty, nurse practitioners, physician assistants)...
February 19, 2018: Liver Transplantation
https://www.readbyqxmd.com/read/29457210/hospital-cirrhosis-volume-and-readmission-in-patients-with-cirrhosis-in-california
#2
Mike Wei, Jason Ford, Qihan Li, Donghak Jeong, Allison J Kwong, Mindie H Nguyen, Matthew S Chang
BACKGROUND: Patients with cirrhosis are at high readmission risk. Using a large statewide database, we evaluated the effect of hospital cirrhosis-related patient volume on 30-day readmissions in patients with cirrhosis. METHODS: We conducted a retrospective study of the Healthcare Cost and Utilization Project State Inpatient Database for adult patients with cirrhosis, as defined by International Classification of Diseases, Ninth Revision (ICD-9) codes, hospitalized in California between 2009 and 2011...
February 19, 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29455437/live-donor-liver-transplantation-for-acute-liver-failure-a-single-center-experience
#3
Siddharth Mehrotra, Naimish Mehta, Prashantha S Rao, Shailendra Lalwani, Vivek Mangla, Samiran Nundy
INTRODUCTION: Acute liver failure (ALF) is an indication for emergency liver transplantation (LT). Although centers performing only deceased donor liver transplants (DDLT) have shown improved outcomes in this situation, they still have relatively long waiting lists. An alternative would be living donor liver transplantation (LDLT), which has shown equivalent outcomes in the elective situation but there is limited evidence of its results in ALF. AIM: The purpose of this study was to assess the outcomes in patients with ALF undergoing emergency LDLT in our center in Delhi, India...
February 17, 2018: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
https://www.readbyqxmd.com/read/29453941/increased-morbidity-and-mortality-associated-with-falls-among-patients-with-cirrhosis
#4
Ghideon Ezaz, Susan L Murphy, Jessica Mellinger, Elliot B Tapper
BACKGROUND: Injuries are more morbid and complicated to manage in patients with cirrhosis. However, data are limited regarding the relative risk of injury and severity of injury from falls in patients with cirrhosis compared to those without cirrhosis. METHODS: We examined the nationally representative National Emergency Department Sample, an all-payer database including all patients presenting with falls 2009-2012. We determined the relative risks for and clinical associations with severe injuries...
February 14, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29452205/impaired-cerebral-microcirculation-induced-by-ammonium-chloride-in-rats-is-due-to-cortical-adenosine-release
#5
Peter Nissen Bjerring, Esben Jannik Bjerrum, Fin Stolze Larsen
BACKGROUND: Liver failure results in hyperammonaemia, impaired regulation of cerebral microcirculation, encephalopathy and death. However, the key mediator that alters cerebral microcirculation remains unidentified. In this study we show that topical ammonium significantly increases periarteriolar adenosine tone on the brain surface of healthy rats and is associated with a disturbed microcirculation. METHODS: Cranial windows were prepared in anaesthetized Wistar rats...
February 13, 2018: Journal of Hepatology
https://www.readbyqxmd.com/read/29451184/the-long-term-outcomes-of-cirrhotic-patients-with-pleural-effusion
#6
Tsung-Hsing Hung, Chih-Wei Tseng, Chih-Chun Tsai, Chen-Chi Tsai, Kuo-Chih Tseng, Yu-Hsi Hsieh
Background/Aim: A pleural effusion is an abnormal collection of fluid in the pleural space and may cause related morbidity or mortality in cirrhotic patients. Currently, there are insufficient data to support the long-term prognosis for cirrhotic patients with pleural effusion. In this study, we investigated the short- and long-term effects of pleural effusion on mortality in cirrhotic patients and evaluated the benefit of liver transplantation in these patients. Patients and Methods: The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to identify 3,487 cirrhotic patients with pleural effusion requiring drainage between January 1, 2007 and December 31, 2010...
January 2018: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
https://www.readbyqxmd.com/read/29446679/video-technique-to-restrict-the-gore-viatorr-stent-graft-for-tips-reduction
#7
Yindee Geeratikun, Hans Timmermans, Barry Uchida, Younes Jahangiri, Masahiro Horikawa, John A Kaufman, Khashayar Farsad
OBJECTIVE: The Viatorr stent-graft (W. L. Gore and Associates), specifically made for transjugular intrahepatic portosystemic shunt (TIPS) creation, has significantly improved TIPS patency compared with bare metal stents. Post-TIPS hepatic encephalopathy (HE), however, remains relatively common after TIPS creation. We describe a technique to secondarily restrict a Viatorr stent-graft to treat post-TIPS refractory HE and maintain use of the Viatorr device. CONCLUSION: We show a simple technique to modify the Viatorr stent-graft for TIPS reduction...
February 15, 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29445232/the-cerebellum-of-patients-with-steatohepatitis-shows-lymphocyte-infiltration-microglial-activation-and-loss-of-purkinje-and-granular-neurons
#8
Tiziano Balzano, Jerónimo Forteza, Pilar Molina, Juan Giner, Ana Monzó, Jennifer Sancho-Jiménez, Amparo Urios, Carmina Montoliu, Vicente Felipo
Peripheral inflammation contributes to minimal hepatic encephalopathy in chronic liver diseases, which could be mediated by neuroinflammation. Neuroinflammation in cerebellum of patients with chronic liver diseases has not been studied in detail. Our aim was to analyze in cerebellum of patients with different grades of liver disease, from mild steatohepatitis to cirrhosis and hepatic encephalopathy: (a) neuronal density in Purkinje and granular layers; (b) microglial activation; (c) astrocyte activation; (d) peripheral lymphocytes infiltration; (e) subtypes of lymphocytes infiltrated...
February 14, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29444470/effect-of-sirolimus-on-liver-cirrhosis-and-hepatic-encephalopathy-of-common-bile-duct-ligated-rats
#9
Kuo-Cheng Wu, Hui-Chun Huang, Ting Chang, Wen-Shin Lee, Chiao-Lin Chuang, I-Fang Hsin, Shao-Jung Hsu, Fa-Yauh Lee, Ching-Chih Chang, Shou-Dong Lee
Cirrhosis is often associated with portal hypertension and portal-systemic collateral vessels formation attributed to angiogenesis, which leads to severe complications as hepatic encephalopathy. Sirolimus has anti-fibrosis and anti-angiogenesis effects, but whether it influences the severity of portal-systemic collaterals and hepatic encephalopathy is unknown. This study was thus designed to address this issue in rats with common bile duct ligation-induced liver cirrhosis. Sham-operated rats were surgical controls...
February 11, 2018: European Journal of Pharmacology
https://www.readbyqxmd.com/read/29432500/large-animals-as-potential-models-of-human-mental-and-behavioral-disorders
#10
REVIEW
Michał Danek, Janusz Danek, Aleksander Araszkiewicz
Many animal models in different species have been developed for mental and behavioral disorders. This review presents large animals (dog, ovine, swine, horse) as potential models of this disorders. The article was based on the researches that were published in the peer-reviewed journals. Aliterature research was carried out using the PubMed database. The above issues were discussed in the several problem groups in accordance with the WHO International Statistical Classification of Diseases and Related Health Problems 10thRevision (ICD-10), in particular regarding: organic, including symptomatic, disorders; mental disorders (Alzheimer's disease and Huntington's disease, pernicious anemia and hepatic encephalopathy, epilepsy, Parkinson's disease, Creutzfeldt-Jakob disease); behavioral disorders due to psychoactive substance use (alcoholic intoxication, abuse of morphine); schizophrenia and other schizotypal disorders (puerperal psychosis); mood (affective) disorders (depressive episode); neurotic, stress-related and somatoform disorders (posttraumatic stress disorder, obsessive-compulsive disorder); behavioral syndromes associated with physiological disturbances and physical factors (anxiety disorders, anorexia nervosa, narcolepsy); mental retardation (Cohen syndrome, Down syndrome, Hunter syndrome); behavioral and emotional disorders (attention deficit hyperactivity disorder)...
December 30, 2017: Psychiatria Polska
https://www.readbyqxmd.com/read/29431486/reducing-recurrent-hospital-admissions-in-patients-with-decompensated-cirrhosis
#11
Richard J Aspinall
Recurrent admissions to hospital are a major issue for people living with decompensated cirrhosis, particularly those who develop chronic hepatic encephalopathy, a condition that leads to significantly impaired quality of life for patients and their family caregivers. Such patients have high health-care use costs but recent data have shown how the appropriate use of effective medical therapy can significantly reduce hospital admissions, length of stay and unplanned readmissions. Redesigning clinical services to optimize access to specialist care and improving the education and support of patients and their carers can further help to reduce the burden of this disease...
February 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29430750/editorial-that-refers-to-article-treating-hepatic-encephalopathy-in-cirrhotic-patients-admitted-to-icu-with-sodium-phenylbutyrate-a-preliminary-study
#12
EDITORIAL
Paul Carrier, Véronique Loustaud-Ratti
Hepatic encephalopathy (HE) management is a hard and unavoidable clinical challenge in cirrhotic patients [1]. This neuropsychological complex syndrome ranges from weak behavior abnormalities to deep coma. Indeed, the presence of HE is a bad prognostic marker, with a mortality rate higher than 50% in the year following the first symptoms [2,3]. Despite its frequency and numerous dedicated studies, pathophysiology is not totally understood [4]. The main documented physiological factors are impaired ammonia metabolism and specific inflammation linked to liver disease [5,6]...
February 11, 2018: Fundamental & Clinical Pharmacology
https://www.readbyqxmd.com/read/29428113/effect-of-probiotic-treatment-on-cirrhotic-patients-with-minimal-hepatic-encephalopathy-a-meta-analysis
#13
Qing Cao, Cheng-Bo Yu, Shi-Gui Yang, Hong-Cui Cao, Ping Chen, Min Deng, Lan-Juan Li
BACKGROUND: Minimal hepatic encephalopathy (MHE) is an early and reversible form of hepatic encephalopathy. The documentations on the treatment with probiotics are inconsistent. The present meta-analysis was to verify the role of probiotics in the treatment of cirrhotic patients with MHE. DATA SOURCES: Seven electronic databases were searched for relevant randomized controlled trials (RCTs) published until July 2015. The effects of probiotics on serum ammonia, endotoxin, and MHE were evaluated...
February 2018: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/29422882/disrupted-brain-intrinsic-networks-and-executive-dysfunction-in-cirrhotic-patients-without-overt-hepatic-encephalopathy
#14
Zhe-Ting Yang, Hua-Jun Chen, Qiu-Feng Chen, Hailong Lin
Objective: Patients with cirrhosis often exhibit cognitive deficits, particularly executive dysfunction, which is considered a predictor of overt hepatic encephalopathy (OHE). We examined brain intrinsic networks associated with executive function to investigate the neural basis of this cognitive deficiency in cirrhosis. Methods: Resting-state functional MRI data were acquired from 20 cirrhotic patients and 18 healthy controls. Seed-based correlation analysis was used to identify the three well-known networks associated with executive function, including executive control (ECN), default mode (DMN), and salience (SN) networks...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29422242/transjugular-intrahepatic-portosystemic-shunt-for-hepatorenal-syndrome-a-systematic-review-and-meta-analysis
#15
REVIEW
Tingxue Song, Martin Rössle, Fuliang He, Fuquan Liu, Xiaozhong Guo, Xingshun Qi
BACKGROUND: Hepatorenal syndrome is a severe complication of advanced liver diseases with a dismal prognosis. AIMS: This systematic review and meta-analysis aims to explore the efficacy and safety of transjugular intrahepatic portosystemic shunt for the treatment of hepatorenal syndrome. METHOD: Publications were searched via PubMed and EMBASE databases. The pooled proportion and mean difference were calculated by using a random-effect model...
February 5, 2018: Digestive and Liver Disease
https://www.readbyqxmd.com/read/29422059/hyperammonemia-alters-membrane-expression-of-glua1-and-glua2-subunits-of-ampa-receptors-in-hippocampus-by-enhancing-activation-of-the-il-1-receptor-underlying-mechanisms
#16
Lucas Taoro-Gonzalez, Yaiza M Arenas, Andrea Cabrera-Pastor, Vicente Felipo
BACKGROUND: Hyperammonemic rats reproduce the cognitive alterations of patients with hepatic encephalopathy, including altered spatial memory, attributed to altered membrane expression of AMPA receptor subunits in hippocampus. Neuroinflammation mediates these cognitive alterations. We hypothesized that hyperammonemia-induced increase in IL-1β in hippocampus would be responsible for the altered GluA1 and GluA2 membrane expression. The aims of this work were to (1) assess if increased IL-1β levels and activation of its receptor are responsible for the changes in GluA1 and/or GluA2 membrane expression in hyperammonemia and (2) identify the mechanisms by which activation of IL-1 receptor leads to altered membrane expression of GluA1 and GluA2...
February 8, 2018: Journal of Neuroinflammation
https://www.readbyqxmd.com/read/29417604/effects-of-alcohol-on-the-brain-in-cirrhosis-beyond-hepatic-encephalopathy
#17
Brian C Davis, Jasmohan S Bajaj
Recent advances have led to a greater understanding of how alcohol alters the brain, both in acute stages (intoxication and alcohol withdrawal) and in chronic misuse. This review focuses on the current understanding of how alcohol affects the brain in cirrhosis patients with and without hepatic encephalopathy. Chronic alcohol use is associated with nutritional deficiencies, dementia, cirrhosis, and decompensating events such as hepatic encephalopathy. Direct toxicity on brain tissue, induction of neuro-inflammation, and alcohol's alterations of the gut microbiome are possible mechanisms for the clinical features of hepatic encephalopathy associated with alcohol use...
February 8, 2018: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/29417024/fulminant-hepatitis-e-in-an-infant
#18
Drishti Tolani, Ira Shah
Hepatitis E virus (HEV) is an enterically transmitted infection that is typically self-limited. It spreads by fecally contaminated water within endemic areas. Hepatitis E infection occurs in both sporadic and epidemic forms in developing countries. HEV infection is usually subclinical in children but in a pregnant woman, it manifests commonly as fulminant hepatic failure. A few cases of acute liver failure caused primarily by HEV infection in children have been reported. We present a case of fulminant hepatitis E in a 1-year-old child...
July 2017: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/29416060/repeated-measures-of-blood-and-breath-ammonia-in-response-to-control-moderate-and-high-protein-dose-in-healthy-men
#19
Lisa A Spacek, Arthur Strzepka, Saurabh Saha, Jonathan Kotula, Jeffrey Gelb, Sarah Guilmain, Terence Risby, Steven F Solga
Ammonia physiology is important to numerous disease states including urea cycle disorders and hepatic encephalopathy. However, many unknowns persist regarding the ammonia response to common and potentially significant physiologic influences, such as food. Our aim was to evaluate the dynamic range of ammonia in response to an oral protein challenge in healthy participants. We measured blood and breath ammonia at baseline and every hour for 5.5 hours. Healthy men (N = 22, aged 18 to 24 years) consumed a 60 g protein shake (high dose); a subset of 10 consumed a 30 g protein shake (moderate dose) and 12 consumed an electrolyte drink containing 0 g protein (control)...
February 7, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29411993/hepatic-encephalopathy-causes-and-health-related-burden
#20
Michelle Clayton
Patients with cirrhosis are at risk of hepatic encephalopathy (HE). While its pathogenesis is not fully understood, the circulation of increased levels of ammonia through the bloodstream to the brain is thought to be a key causative factor. The ammonia penetrates the blood-brain barrier, ultimately leading to cerebral oedema. This can result in cognitive impairments, which can exhibit in multiple ways, adversely affecting quality of life for both patients and their families. The need for hospitalisation and longer hospital stays associated with HE has cost implications for the health service...
February 7, 2018: British Journal of Nursing: BJN
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