| [ Summary ] |
Hepatic encephalopathy is a syndrome with a wide variety of neuropsychiatric manifestations, due to severe hepatic insufficiency. The clinical classifications of hepatic encephalopathy include; 1) the acute type which is typical in fuluminant hepatitis, 2-a) the endstage coma type and 2-b) the chronic recurrent type, both end stage coma and 2-b chronic recurrent types are seen in portal hypertension. Encephalopathy is often preceded by constipation in the chronic recurrent type and by severe gastrointestinal bleeding in the endstage coma type. This syndrome is caused by toxins produced in the gut such as ammonia, an imbalance of plasma amino acids, and increased GABA-mediated neurotransmission. Treatment of this syndrome consists of correction of precipitating factors, and administration of nonabsorbable disaccharides, and antibiotics. Fischer's solution improves 98% of patients with chronic recurrent type hepatic coma. Interventional radiology to reduce the blood flow from the portasystemic shunt is also effective. |