Pathogenesis, diagnosis, and treatment of hepatic encephalopathy.
Hepatic encephalopathy (HE) is a neuropsychiatric disorder seen in patients with advanced liver disease or porto-systemic shunts. Based on etiology and severity of HE, the World Congress of Gastroenterology has divided HE into categories and sub-categories. Many user-friendly computer-based neuropsychiatric tests are being validated for diagnosing covert HE. Currently, emphasis is being given to view HE deficits as a continuous spectrum rather than distinct stages. Ammonia is believed to play crucial role in pathogenesis of HE via astrocyte swelling and cerebral edema. However, evidence has been building up which supports the synergistic role of oxidative stress, inflammation and neurosteroids in pathogenesis of HE. At present, treatment of HE aims at decreasing the production and intestinal absorption of ammonia. But as the role of new pathogenetic mechanisms becomes clear, many potential new treatment strategies may become available for clinician.
['Atluri|Dileep K|DK|', 'Prakash|Ravi|R|', 'Mullen|Kevin D|KD|']
pathogenesis Diagnosis treatment hepatic encephalopathy AAA, aromatic amino acid BAUR, brain ammonia utilization rate BCAA, branched-chain amino acids CFF, critical flicker fusion DBI, diazepam binding inhibitor DST, digit symbol test DWI, diffusion weighted imaging ECAD, extra-corporeal albumin dialysis EEC, electroencephalogram FLAIR, fluid attenuation inversion recovery HE, hepatic encephalopathy HESA, hepatic encephalopathy scoring algorithm ICT, inhibitory control test IL, interleukin LOLA, L-ornithine L-aspartate LTT, line tracing test MARS, molecular adsorbent reticulating system MHE, minimal hepatic encephalopathy MRI, magnetic resonance imaging NAC, N-acetyl cysteine NO, nitric oxide NS, neurosteroids NSAID, non-steroidal anti-inflammatory drugs ODN, octadecaneuropeptide OHE, overt hepatic encephalopathy PTBR, peripheral-type benzodiaze-pine receptor QOL, quality of life SDT, serial dotting test SEDACA, short epoch, dominant activity, and cluster analysis SIBO, small intestinal bacterial overgrowth SIRS, systemic inflammatory response syndrome SOD, Superoxide dismutase SONIC, spectrum of neurological impairment TLP, TransLocator Protein TNF, tumor necrosis factor