Patient Case A 43-year-old White male with metabolic syndrome presented with complaints of fatigue and feeling distracted. Blood work showed a mild increase in aspartate aminotransferase […]
Abstract: Hepatic encephalopathy (HE) is a condition that encompasses a range of neuropsychiatric abnormalities in patients with significant liver disease. Overt HE occurs in approximately […]
A Step-by-Step Approach to the Diagnosis and Management of Hepatic Encephalopathy in the United States, and Primary Biliary Cholangitis: Diagnosis and Management
Gastroenterology & Hepatology December 2016, Volume 12, Issue 12, Supplement 5 A Step-by-Step Approach to the Diagnosis and Management of Hepatic Encephalopathy in the United […]
Abstract: Hepatic encephalopathy (HE) represents a broad continuum of neuropsychological dysfunction in patients with acute or chronic liver disease and/or portosystemic shunting of blood flow. The pathophysiology of this disease is quite complex, as it involves overproduction and reduced metabolism of various neurotoxins, particularly ammonia. Recent hypotheses implicate low-grade cerebral edema as a final common pathway for the pathophysiology of HE. Management of this condition is multifaceted and requires several steps: elimination of precipitating factors; removal of toxins, both by reducing them at their source and by augmenting scavenging pathways; modulation of resident fecal flora; proper nutritional support; and downregulation of systemic and gut-derived inflammation.