title: Reversal of hepatic encephalopathy and alteration in amino acid profiles after blocking a surgical splenorenal shunt by interventional radiological techniques.
abstract: Portal-systemic shunts are effective in preventing haemorrhage from varices in portal hypertension, but at the price of hepatic encephalopathy. We describe the blockage of a splenorenal shunt using interventional radiology, in a patient with incapacitating chronic encephalopathy. The procedure successfully reversed encephalopathy, without haemodynamic disturbances or haemorrhage from recurrent varices and was associated with a return of the plasma amino acid profile towards normal, with a reduction in aromatic amino acids and an increase in branch chain amino acids. This observation supports the hypothesis that changes in plasma amino acid profiles in patients with portal-systemic shunting are due to the diversion of portal blood rather than the underlying chronic liver disease.
authors.affiliation: Department of Medicine, Royal Postgraduate Medical School, London, U.K.
authors.forename: B
authors.initials: B
authors.lastname: Clarke
authors.forename: M J
authors.initials: MJ
authors.lastname: Ellis
authors.forename: V
authors.initials: V
authors.lastname: Leung
authors.forename: E
authors.initials: E
authors.lastname: Hughes
authors.forename: J H
authors.initials: JH
authors.lastname: Meek
authors.forename: D J
authors.initials: DJ
authors.lastname: Allison
authors.forename: H J
authors.initials: HJ
authors.lastname: Hodgson
mesh_terms: D000596:Amino Acids / Q000097:blood*; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008111:Liver Function Tests; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects*; D011859:Radiography
chemical_list: D000596:Amino Acids