Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy

Year 1974, Volume: 27 Issue: 1-2, 439 - 450, 30.06.1974

Esat Erenoğlu

https://izlik.org/JA82BM29RS

Abstract

Hepatic encephalopathy is a serious neuropsychiatric complication arising in patients with advanced liver disease or portal–systemic shunts, and may present acutely in massive liver necrosis or chronically in cirrhosis. Clinical features range from subtle behavioral changes, agitation and asterixis to stupor, coma, and transient focal neurological signs. The pathogenesis remains incompletely understood, but ammonia intoxication—augmented by increased intestinal production and impaired hepatic clearance—and short‐chain fatty acids, cerebral edema, and false neurotransmitters all contribute.

Treatment of chronic encephalopathy focuses on lowering systemic ammonia via dietary protein restriction, nonabsorbable disaccharides (lactulose), poorly absorbed antibiotics (neomycin or alternatives), correction of acid–base and electrolyte imbalances, and adjunctive levodopa. In acute fulminant cases, these measures often produce only transient improvement. More invasive therapies—exchange transfusion, dialysis, extracorporeal liver perfusion—can stabilize patients and buy time for potential liver transplantation, although definitive reversal remains rare in fulminant hepatic failure.

Keywords

Hepatic encephalopathy , Acute liver failure , Chronic liver disease , Ammonia toxicity , Lactulose therapy , Neomycin , Levodopa , Exchange transfusion

Akut ve Kronik Hepatik Ensefalopatinin Tanınması ve Tedavisi

https://izlik.org/JA82BM29RS

Abstract

Hepatik ensefalopati; ileri karaciğer hastalığı veya portal–sistemik anastomozu olan olgularda, davranış değişikliklerinden asteriksi ve koma düzeyine kadar geniş bir klinik tabloya yol açan önemli bir komplikasyondur. Akut fulminan hepat nekrozunda nörolojik bozukluklar hızla ilerlerken, kronik siroz vakalarında ensefalopati genellikle dalgalı bir seyir izler. Patogenezde amonyak birincil rol oynar; bağırsakta artan üretim, karaciğerde azalan detoksifikasyon ve merkezi sinir sisteminde oluşan ödem ve yalancı nörotransmitterler klinik ağırlaşmayı belirler.

Kronik ensefalopatide tedavi; diyetle protein kısıtlaması, laktoz ve neomisin gibi barsak kaynaklı amonyak üretimini azaltan ilaçlar, asit–baz ve elektrolit dengesinin düzeltilmesi ile levodopa eklenmesine dayanır. Akut olgularda bu konservatif yaklaşımlar genellikle geçici düzelme sağlar. Değişimli transfüzyon, diyaliz veya ekstrakorporeal karaciğer perfüzyonu gibi invazif yöntemler, olguyu stabilize edip karaciğer transplantasyonu için zaman kazandırabilir; ancak fulminan hepatik nekrozda kalıcı iyileşme nadirdir.

Keywords

Hepatik ensefalopati , Akut karaciğer yetersizliği , Kronik karaciğer hastalığı , Amonyak toksisitesi , Laktoz kullanım , Neomisin , Levodopa , Değişimli transfüzyon

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