Hepatic encephalopathy.
Hepatic encephalopathy (HE) occurs in severe hepatic insufficiency following either a drastic reduction of the functioning hepatic mass or porto-systemic shunt. Clinical symptoms may present in acute, chronic or recurrent forms and are characterized by disturbances of consciousness, intellectual, personality and behavioral alterations as well as neuromuscular signs. The pathogenesis of HE is still not completely clear. An important role continues to be attributed to ammonia, although the dysmetabolic aminoacid and neurotransmission systems are at present under particular scrutiny. Diagnosis of HE is generally easy, yet the true diagnostic "problem" lies in identifying the at-risk cirrhotic patient for correct orientation of his or her psychosocial and therapeutic management. The first step consists in identification and removal of the precipitating causes. Catharctic agents and branched chain aminoacids may subsequently be utilized. Present studies on the use of anti-benzodiazepine drugs seem to be bringing forth new prospects.
Ventura
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Istituto di Clinica Medica III, Università degli Studi, Modena, Italy.
D000818:Animals; D003937:Diagnosis, Differential; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male