scholarly journals Hepatic encephalopathy: issues relevant to clinical practice

2021 ◽  
pp. 104-108
Author(s):  
M. V. Maevskaya
Keyword(s):  
Liver Cirrhosis ◽  
Clinical Practice ◽  
Hepatic Encephalopathy ◽  
Clinical Signs ◽  
Ammonia Concentration ◽  
High Concentration ◽  
Expert Opinions ◽  
Diagnostic Role ◽  
Cirrhotic Patients

Hepatic encephalopathy (HE) remains one of the most serious complications of liver cirrhosis. Its clinical spectrum sometimes creates difficulties in the optimal diagnosis at the patient’s bedside and treatment. To present new data on the field of clinical management of cirrhotic patients with hepatic encephalopathy. The role of ammonia in the diagnosis of HE is still under discussion. In clinical practice, in patients with suspected overt HE, normal ammonia concentration can be used to exclude this diagnosis. In contrast, a high concentration of ammonia in the absence of clinical signs of HE should not serve as a criterion for this diagnosis and as a guide for treatment. A separate issue for discussion is the covert HE. The simplest and most affordable test for screening for covert HE and evaluating the effectiveness of therapy is the animal naming test, which can be done on bedside by physician or caregivers. Patients with covert HE need treatment that is similar in approach to overt HE. The diagnosis of overt HE and the methods of its therapy are well known. According to Russian recommendations, depending on the disease course in a certain patient, lactulose, rifaximin, L-ornithine L-aspartate can be used as first-line drugs, which is applicable to the treatment of both overt and latent PE. The main issues on the management of HE in liver cirrhosis relate to the diagnostic role of ammonia, optimal diagnosis and treatment strategy for covert HE, therapy of choice for both overt and latent HE. There are expert opinions and consensus documents on all these issues. Treatment of overt and latent PE is carried out according to the same principles. Drugs of choice: lactulose, rifaximin and L-Ornithine L-Aspartate.

scholarly journals The impact of PNPLA3 and TM6SF2 in cirrhosis related complications

2021 ◽  
Author(s):  
Haruki Uojima ◽  
Xue Shao ◽  
Taeang Arai ◽  
Yuji ogawa ◽  
Toru Setsu ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Odds Ratio ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Fibrosis Progression ◽  
Cirrhotic Patients ◽  
The Impact

Patatin-like phospholipase domain-containing 3 (PNPLA3) and transmembrane 6-superfamily member 2 (TM6SF2) polymorphisms have major impact for fibrosis due to steatohepatitis. However, there are scant data about correlations between cirrhosis-related complications and the polymorphisms of these genes. Therefore, we aimed to determine the role of the PNPLA3 and TM6SF2 polymorphisms in fibrosis progression for patients with liver cirrhosis. A multicenter study was performed at six hospitals in Japan enrolling 400 patients with liver cirrhosis caused by virus (n = 157), alcohol (n = 104), nonalcoholic fatty liver disease (NAFLD) (n = 106), or autoimmune disease (n = 33). These cirrhotic patients included those with complications of variceal bleeding, hepatic ascites, and/or hepatic encephalopathy and those without. To assess the role of the PNPLA3 and TM6SF2 polymorphisms in patients with cirrhosis related complications, we calculated the odds ratio and relative risk for the rs738409 and rs58542926 polymorphisms. We also accessed whether or not the interaction between these two polymorphisms contributed to cirrhosis related complications. As a result, the odds ratio for complications in the NAFLD group significantly increased in the presence of the rs738409 GG genotype when the CC genotype was used as the reference. There were no significant risks between complications and the presence of the rs738409 G allele in the virus or alcohol groups. There were no significant risks of complications in the frequency of the rs58542926 T polymorphism regardless of the etiology of liver cirrhosis. The interaction between the trs738409 and rs58542926 polymorphisms had the highest odds ratio of 2.415 for complications in the rs738409 GG + rs58542926 (CT+TT) group when rs738409 (CC+CG) + TM6SF2 CC was used as the reference in the NAFLD group.

Serum Zinc Levels in Cirrhotic Patients Attending General and Specialty Hospitals, Yangon

2019 ◽  
Vol 31 (3) ◽  
pp. 251-256
Keyword(s):  
Clinical Practice ◽  
Hepatic Encephalopathy ◽  
Zinc Deficiency ◽  
Serum Zinc ◽  
Zinc Level ◽  
The Body ◽  
Serum Zinc Level ◽  
Cross Sectional ◽  
Cirrhotic Patients ◽  
Cirrhosis Of Liver

Cirrhosis of liver is one of the common medical problem in daily clinical practice and one of the leading causes of morbidity and mortality. Zinc is an essential trace elements for human and plays in many biological roles in the body. Among them, zinc deficiency is thought to be involved in metabolism of ammonia and causes hyperammonia that worsen hepatic encephalopathy. This study aimed to find out the severity of cirrhosis of liver was by Child Turcotte Pugh score and to investigate the associations between serum zinc level and severity of cirrhosis. A hospital-based cross-sectional descriptive study was performed on 78 patients with different underlying causes of cirrhosis of liver at the Medical Units of Yangon General Hospital and Yangon Specialty Hospital. Among the study population, Child grade A was found to be 28.21%, Child grade B was 30.77% and Child grade C was 41.03%. Regarding result of serum zinc level, 62.8% were low level, 28.2% were within normal level and 8.9% were high level. Mean value of serum zinc level in grade A was 0.68 mg/l, grade B was 0.54 mg/l and grade C was 0.48 mg/l (p=0.00). It was found out that there was a high prevalence of zinc deficiency in severe cirrhotic patients. The zinc level was significantly lowest among patients with Child-Pugh C as compare to those with Child-Pugh B and C. Severity of zinc deficiency should be requested for supplementation therapy in cirrhotic patients as to prevent complications such as hepatic encephalopathy, hepatocellular carcinoma and liver failure. Screening for zinc deficiency may need in these patients with more advanced cirrhosis because it seems to be a marker of advanced liver disease and it can be deducted that awareness of serum zinc level among cirrhotic patients is very important in clinical practice.

scholarly journals Normalisation of the psychometric encephalopathy score within the Cameroonian population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Larissa Pessidjo Djomatcho ◽  
Mathurin Pierre Kowo ◽  
Antonin Ndjitoyap Ndam ◽  
Sylvain Raoul Simeni Njonnou ◽  
Gabin Ulrich Kenfack ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Healthy Volunteers ◽  
Clinical Signs ◽  
Minimal Hepatic Encephalopathy ◽  
Education Level ◽  
Multicentric Study ◽  
Tracing Test ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Number Connection Test

Abstract Background Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. The aim of this study was to standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods This was a prospective, multicentric study from 1 December 2018 to 31 July 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the number connection test-A, number connection test-B, serial dotting test, line tracing test were expressed in seconds and those of the digit symbol test in points. Results A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3 ± 15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62 ± 3.9 years in cirrhotic patients. The PHES of the healthy volunteer group was − 0.08 ± 1.28 and the cut-off between normal and pathological values was set at − 3 points. PHES of the cirrhotic patients was − 7.66 ± 5.62 points and significantly lower than that of volunteers (p < 0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE. Conclusion PHES cut-off value in Cameroonians is − 3, with MHE prevalence of 74% among cirrhotic patients.

Role of the determination of partial pressure of ammonia in cirrhotic patients with hepatic encephalopathy

2002 ◽  
Vol 36 ◽  
pp. 207
Author(s):  
Francesca Nicolao ◽  
Cesare Efrati ◽  
Andrea Masini ◽  
Manuela Merli ◽  
Adolfo Francesco Attili ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Partial Pressure ◽  
Partial Pressure Of Ammonia ◽  
Cirrhotic Patients

scholarly journals Low Serum 25-Hydroxy Vitamin D (25-OHD) and Hepatic Encephalopathy in HCV-Related Liver Cirrhosis

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Mohamed Abd Ellatif Afifi ◽  
Ahmed Mohamed Hussein ◽  
Mahmoud Rizk
Keyword(s):  
Vitamin D ◽  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Wide Spectrum ◽  
The Other ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Cirrhotic Patients ◽  
Low Serum

Background. Patients with liver cirrhosis experience a large variety of metabolic disorders associated with more hepatic decompensation. Hepatic encephalopathy (HE) is a significant complication in liver cirrhosis patients, presenting a wide spectrum of neuropsychological symptoms. A deficiency of 25-hydroxy vitamin D (25-OHD) in the general population is associated with a loss of cognitive function, dementia, and Alzheimer’s disease. Aim of the Study. Our study aims to check the relationship between low serum 25-OHD and HE in patients with HCV-related liver cirrhosis and assess its link with patient mortality. Patients and Methods. This study was observationally carried out on 100 patients with HCV-related liver cirrhosis. The patients were divided into 2 groups: Group A—included 50 HCV-related cirrhotic patients with HE, and Group B—included 50 HCV-related cirrhotic patients without HE. Assessment of disease severity using the end-stage liver disease (MELD) model and Child Turcotte Pugh (CTP) scores were done, and 25-OHD levels were measured. Comparison of vitamin D levels in different etiologies and different CTP categories was made using one-way ANOVA. Pearson’s correlation between the level of vitamin D and other biomarkers was applied. Results. There was a statistically significant Vitamin D level difference between the two groups. A lower level of vitamin D was observed in the HE group where the severe deficiency was 16%, while it was 6% in the other group and the moderate deficiency was 24% in HE group as compared to 10% in the other group. The insufficient vitamin D level represented 46% of the non-HE group while none of the HE group falls in this category. Vitamin D level was statistically higher in Grade 1 HE than in Grade 2 which is higher than in Grades 3 to 4. Vitamin D level was also significantly higher in those who improved from HE as compared to those who died. Conclusion. The lower levels of 25-OHD were associated with the higher incidence of HE in cirrhotic HCV patients. The worsening vitamin D deficiency was associated with increased severity of the liver disease, so vitamin D may be considered a prognostic factor for the severity of liver cirrhosis and high mortality rate in HE patients.

scholarly journals Hepatic Encephalopathy: From the Pathogenesis to the New Treatments

2014 ◽  
Vol 2014 ◽  
pp. 1-16 ◽  
Author(s):  
Juan Cordoba
Keyword(s):  
Clinical Trials ◽  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Prospective Studies ◽  
Hepatic Dysfunction ◽  
Short Term ◽  
Multiple Factors ◽  
Short Term Mortality ◽  
Cirrhotic Patients ◽  
New Treatments

Hepatic encephalopathy is a frequent and serious complication of liver cirrhosis; the pathophysiology of this complication is not fully understood although great efforts have been made during the last years. There are few prospective studies on the epidemiology of this complication; however, it is known that it confers with high short-term mortality. Hepatic encephalopathy has been classified into different groups depending on the degree of hepatic dysfunction, the presence of portal-systemic shunts, and the number of episodes. Due to the large clinical spectra of overt EH and the complexity of cirrhotic patients, it is very difficult to perform quality clinical trials for assessing the efficacy of the treatments proposed. The physiopathology, clinical manifestation, and the treatment of HE is a challenge because of the multiple factors that converge and coexist in an episode of overt HE.

FIBRINOPEPTIDE B6 15-42 IN LIVER CIRRHOSIS: A SENSITIVE INDICATOR OF MILD FIBRINOLYSIS ACTIVATION

1987 ◽  
Author(s):  
F Marongiu ◽  
M R Acca ◽  
G Mulas ◽  
M Conti ◽  
G Sorano ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Plasminogen Activators ◽  
Fibrinopeptide A ◽  
A Posteriori ◽  
Plasmin Activity ◽  
Coagulation Activation ◽  
Cirrhotic Patients ◽  
Student’S T ◽  
Student’S T Test

In order to detect even minimal fibrinolysis activation in liver cirrhosis and to investigate whether an increased plasmin activity is related to a mild blood coagulation activation, we measured fibrinopeptide A (FPA) (Mailinckrodt) and fibrinopeptide BB 15-42 (BB 15-42) (IMCO and SORIN Biomedica) in 26 patients (16 men and 10 women, mean age 55.8 ± 13.1 years) with histologically proven liver cirrhosis..Mann-Whitney test, Student’s t test and correlation coefficient r were employed for statistical analysis when appropriate.FPA and BB 15-42 were not normal distributed and thus their levels were exprsessed as median and range.FPA values were significantly different in cirrhotic patients (3.9, 0.9-24.2 ng/ml) from those of the controls (2.5, 0.5-3.9 ng/ml) (p < 0.01).BB 15-42 levels were significantly higher in cirrhotic patients (19.4, 7.1-103.1 ng/ml) than in controls (10.4, 5.1-15.4 ng/ml) (p < 0.01). A posteriori the patients were divided in two subgroups according to whether their FPA levels were high (subgroup 1, n=10, FPA>4.0 ng/ml) or normal (subgroup 2, n=16, FPA < 4.0 ng/ml).In patients with high FPA levels we found higher levels of BB 15-42 (22.2, 9.9-103.1 ng/ml) than in patients with normal FPA (13.6, 7.1-30.7 ng/ml ).Thvis difference was significant (p < 0.02) .There was no relationship between FPA and BB 15-42.Our data indicate that in liver cirrhosis a mild fibrinolysis activation may occur.The role of a chronic intravascular coagulation appears to be significant in this regard.However the impaired clearance of plasminogen activators, the decreased synthesis of fibrinolysis inhibitors and the decreased levels of hystidine rich glycoprotein may be also involved in determining fibrinolysis activation as suggested by the lack of correlation between FPA and BB 15-42.

scholarly journals Lifestyle, Nutritional Status and Seroclinical Profile of Liver Cirrhotic Patients

1970 ◽  
Vol 36 (2) ◽  
pp. 44-47
Author(s):  
Touhida Ahsan ◽  
Monira Ahsan ◽  
Md Mustafa Kamal ◽  
Kaji Jahangir Hossain ◽  
Mohammed Emdadul Haque ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Nutritional Status ◽  
Energy Intake ◽  
Clinical Signs ◽  
College Hospital ◽  
Housing Status ◽  
Medical College ◽  
Cirrhotic Patients ◽  
Almost All ◽  
Medical University

Liver cirrhotic patients were investigated for their lifestyle, energy intake, BMI, biochemical and serological indices and prevalent clinical signs. The study included 50 liver cirrhotic patients who were hospitalized in Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and BIRDEM Hospital during the period of 1999-2000. Of the fifty cirrhotic patients, hepatitis B virus infection was found responsible for 52% (n=26) of liver cirrhosis, hepatitis C was for only 6% (n=3) patients and etiology for the rest 42% (n=21) patients could not be identified. It was observed that literate, low-mid income and productive male were being suffering from the liver cirrhosis. The patients had good housing status. Low energy intake (1670.6±42.9) and low BMI (19.52±3.48) were present in almost all of the patients. Mean serum haemoglobin, total proteins, and albumin were 96.2±20.5g/L, 63.1±1.01g/L, and 31.30±0.93g/L respectively. Serum bilirubin was raised in 50% patients. Serum SGPT and SGOT levels were increased from 2 to 4 folds in 50% of the patients; alkaline phosphatase was increased only in 8% cirrhotic patients. Anaemia, PEM, ascities, oedema, muscle wasting were prevalently present in vast majority of the patients. Key words: Liver cirrhosis, nutritional status, liver function determinants   DOI: 10.3329/bmj.v36i2.3611 Bangladesh Medical Journal 36(2) 2007 44-47

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