[The diagnostics and therapy of hepatic encephalopathy. Recommendations of of the working group on portal hypertension in the Czech Hepatology Society and the J. E. Purkinje Czech Medical Society].
Hepatic encephalopathy (HE) is a set of reversible neuropsychic features which occur in connection with hepatic cirrhosis or acute hepatic failure. We distinguish manifest HE (with clinical symptoms) and minimal FE (normal clinical finding, abnormal psychometric or neurophysiologic exam). The diagnosis is clinical or laboratory one. From the auxiliary examinations in common practice the number connection test is sufficient.


METHODS
Presence of hepatic encephalopathy should lead to the consideration of the possibility to solve basic disease by hepatic transplantation. Conservative therapy lies in 1. Basic disease elimination, 2. Measures lowering the ammonia level in blood--optimalization of protein intake, administration of indigestible disaccharides (lactulose, lactitol) and fill sterilisation by antibiotics (Rifaxin, Metronidazol), ornitine-aspartate administration, 3. Influencing the changes in amino acid metabolism (administration of branched chain amino acids--BCAA). Prognosis depends on the advancement of the disease, after hepatic transplantation the clinical symptoms of HE are mostly fully reversible.
Brůha
R
R
IV interni klinika 1. lékarské fakulty UK a VFN, Praha. bruha@cesnet.cz
Drastich
P
P
Hůlek
P
P
Lata
J
J
Petrtýl
J
J
Procházka
V
V
Spicák
J
J
Vanásek
T
T
Volfová
M
M
Zdenĕk
P
P
D000328:Adult; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged