Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy

Esat Erenoğlu

EN TR

Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy

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

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

References

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Details

Primary Language

English

Subjects

Gastroenterology and Hepatology

Journal Section

Research Article

Authors

Esat Erenoğlu This is me
Türkiye

Publication Date

June 30, 1974

Submission Date

January 1, 1974

Acceptance Date

March 31, 1974

Published in Issue

Year 1974 Volume: 27 Number: 1-2

IZ

https://izlik.org/JA82BM29RS

APA

Erenoğlu, E. (1974). Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 27(1-2), 439-450. https://izlik.org/JA82BM29RS

AMA

1.Erenoğlu E. Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 1974;27(1-2):439-450. https://izlik.org/JA82BM29RS

Chicago

Erenoğlu, Esat. 1974. “Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 27 (1-2): 439-50. https://izlik.org/JA82BM29RS.

EndNote

Erenoğlu E (June 1, 1974) Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy. Ankara Üniversitesi Tıp Fakültesi Mecmuası 27 1-2 439–450.

IEEE

[1]E. Erenoğlu, “Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 27, no. 1-2, pp. 439–450, June 1974, [Online]. Available: https://izlik.org/JA82BM29RS

ISNAD

Erenoğlu, Esat. “Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 27/1-2 (June 1, 1974): 439-450. https://izlik.org/JA82BM29RS.

JAMA

1.Erenoğlu E. Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 1974;27:439–450.

MLA

Erenoğlu, Esat. “Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 27, no. 1-2, June 1974, pp. 439-50, https://izlik.org/JA82BM29RS.

Vancouver

1.Esat Erenoğlu. Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy. Ankara Üniversitesi Tıp Fakültesi Mecmuası [Internet]. 1974 Jun. 1;27(1-2):439-50. Available from: https://izlik.org/JA82BM29RS

Recognition and Treatment of Acute and Chronic Hepatic Encephalopathy

Abstract

Keywords

Akut ve Kronik Hepatik Ensefalopatinin Tanınması ve Tedavisi

Abstract

Keywords

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

IZ

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