Role Of Nutrition In The Management Of Hepatic Encephalopathy In End-stage Liver Failure

2013 ◽  
pp. 109-138
Keyword(s):  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
End Stage

scholarly journals Role of Nutrition in the Management of Hepatic Encephalopathy in End-Stage Liver Failure

2010 ◽  
Vol 2010 ◽  
pp. 1-12 ◽  
Author(s):  
Chantal Bémeur ◽  
Paul Desjardins ◽  
Roger F. Butterworth
Keyword(s):  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
The Body ◽  
Significant Prognostic Factor ◽  
Protein Requirements ◽  
Patients At Risk ◽  
End Stage ◽  
Inadequate Dietary Intake

Malnutrition is common in patients with end-stage liver failure and hepatic encephalopathy, and is considered a significant prognostic factor affecting quality of life, outcome, and survival. The liver plays a crucial role in the regulation of nutrition by trafficking the metabolism of nutrients, their distribution and appropriate use by the body. Nutritional consequences with the potential to cause nervous system dysfunction occur in liver failure, and many factors contribute to malnutrition in hepatic failure. Among them are inadequate dietary intake, malabsorption, increased protein losses, hypermetabolism, insulin resistance, gastrointestinal bleeding, ascites, inflammation/infection, and hyponatremia. Patients at risk of malnutrition are relatively difficult to identify since liver disease may interfere with biomarkers of malnutrition. The supplementation of the diet with amino acids, antioxidants, vitamins as well as probiotics in addition to meeting energy and protein requirements may improve nutritional status, liver function, and hepatic encephalopathy in patients with end-stage liver failure.

scholarly journals Role of Hepatitis E Virus Infection in Acute-on-Chronic Liver Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Mario Frias ◽  
Pedro López-López ◽  
Antonio Rivero ◽  
Antonio Rivero-Juarez
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Hepatitis E Virus ◽  
Hepatitis E ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Hepatic Decompensation ◽  
End Stage ◽  
The Impact

Chronic liver disease (CLD) with a variety of causes is currently reported to be one of the main causes of death worldwide. Patients with CLD experience deteriorating liver function and fibrosis, progressing to cirrhosis, chronic hepatic decompensation (CHD), end-stage liver disease (ESLD), and death. Patients may develop acute-on-chronic liver failure (ACLF), typically related to a precipitating event and associated with increased mortality. The objective of this review was to analyze the role of acute hepatitis E virus (HEV) infection in patients with CLD, focusing on the impact of this infection on patient survival and prognosis in several world regions.

Chronic Hepatic Failure

2019 ◽  
Author(s):  
Derek J Erstad ◽  
Motaz Qadan
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
End Stage Liver Disease ◽  
End Stage

Continued hepatic injury by genetic or environmental factors results in a state of chronic inflammation, fibrosis, and progressive hepatocyte dysfunction that can progress to cirrhosis and end stage liver disease (ESLD). Cirrhosis is the eighth leading cause of mortality in the United States, while the burden of disease is even greater in regions with endemic viral hepatitis. Common risk factors include a history of hepatitis; alcohol or IV drug abuse; use of certain medications; and other risk factors associated with transmission of viral hepatitis, including tattoos, sexual promiscuity, and incarceration. Although many patients with cirrhosis are asymptomatic and remain undiagnosed, many will eventually develop secondary complications from chronic liver failure, which can be difficult to manage and are associated with significant morbidity, including: portal hypertension, variceal bleeding, coagulopathy, hepatic encephalopathy, and renal failure. In addition, hepatocellular carcinoma (HCC) is estimated to be 30 times more common among patients with cirrhosis, which can be an aggressive malignancy with 5-year overall survival of less than 15%. In this chapter, we provide a comprehensive overview of chronic liver failure, including the epidemiology of cirrhosis, pathophysiology of liver injury, and assessment and management of cirrhosis and associated downstream complications. Finally, we discuss the role of liver transplantation for both ESLD and HCC. This review contains 6 figures, 9 tables, and 53 references. Key Words: chronic liver failure, cirrhosis, coagulopathy, end stage liver disease, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, liver transplantation, portal hypertension, varices

Expanding the Boundaries of Combined Renal Replacement Therapy for Non-Renal Indications

2018 ◽  
Vol 47 (1-3) ◽  
pp. 69-72 ◽  
Author(s):  
Mayanka Kamboj ◽  
Amir Kazory
Keyword(s):  
Hepatic Encephalopathy ◽  
Renal Replacement Therapy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Replacement Therapy ◽  
Ammonia Level ◽  
Clinical Aspects ◽  
Optimal Timing ◽  
The Impact

Over the last decades, there have been major advancements in the field of renal replacement therapy (RRT) with utilization of newer technologies and advent of various modalities. Once exclusively used for treatment of renal failure and its metabolic consequences, the science of RRT has expanded to include non-renal indications such as treatment of fluid overload in patients with refractory heart failure. Hepatic encephalopathy due to sudden rise in serum ammonia level in the setting of acute liver failure represents an underexplored area in which RRT can potentially be helpful. While the key role of hyperammonemia in the pathogenesis of hepatic encephalopathy in patients with liver failure is well established, emerging data points to distinct pathophysiologic mechanisms underlying chronic alterations in neural metabolic functions and acute changes in cerebral perfusion. In the acute setting, ammonia can cross the blood–brain barrier at high levels leading to sudden formation of strong osmolytes, significant transcellular shift of water, and cerebral edema. Herein, we provide a brief overview of the role of RRT in management of acute hyperammonemia in the setting of acute liver failure and discuss the practical aspects of the available therapeutic modalities. Larger studies are needed to shed light on a number of clinical aspects such as the impact on the outcomes, criteria for selection of the patients that would benefit most from this therapeutic approach, optimal timing of initiation of RRT, and the most appropriate modality.

scholarly journals Liver Transplantation in Patients with Acute-onChronic Liver Failure: Challenging the Limits

2021 ◽  
pp. 61-69
Author(s):  
Juan Manuel Diaz ◽  
Ezequiel Mauro ◽  
Maria Nelly Gutierrez-Acevedo ◽  
Adrian Gadano ◽  
Sebastian Marciano
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Causes Of Death ◽  
Meld Score ◽  
Organ Allocation ◽  
Short Term ◽  
Before And After ◽  
Short Term Mortality ◽  
End Stage

Acute-on-chronic liver failure (ACLF) is one of the main causes of death on the waiting list. Liver transplantation (LT) is the only curative treatment for patients with ACLF and therefore it should be considered in all cases. However, the applicability of LT in patients with ACLF is challenging, given the scarcity of donors and the high short-term mortality of these patients. Organ allocation has traditionally been prioritised according to the model for end-stage liver disease (MELD) system. However, the accuracy of MELD score is limited in patients with ACLF. In this article, the authors review the outcomes of patients with ACLF before and after LT, highlighting its clinical course, the feasibility of LT in the sickest patients, the role of the organ allocation system, and possible indicators of futility.

Pediatric acute liver failure: Etiology, outcomes, and the role of serial pediatric end-stage liver disease scores

2013 ◽  
Vol 17 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Jeremy Rajanayagam ◽  
David Coman ◽  
David Cartwright ◽  
Peter J. Lewindon
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
End Stage Liver Disease ◽  
End Stage ◽  
Pediatric Acute Liver Failure
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