| Theme |
Cirrhosis -- Recent Progress in Diagnosis and Treatmen |
| Title |
Diagnosis and Treatment of Hepatic Encephalopathy |
| Author |
Hiroshi Fukui |
Third Department of Internal Medicine, Nara Medical University |
| [ Summary ] |
The development of hepatic encephalopathy in patients with liver cirrhosis has been explained by the effects of hyperammonemia and inflammation on the astrocytes, the only cells in the brain that can metabolize ammonia. An accumulation of ammonia and inflammatory cytokines induces swelling of the astrocytes and stimulates reactive oxygen species, reactive nitrogen species and the benzodiazepine receptors. This may in turn exaggerate brain edema and encephalopathy. Hepatic encephalopathy is frequently associated with systemic inflammatory response syndrome (SIRS), which may be attributable to bacterial translocation and endotoxemia.
To make an early diagnosis of minimal encephalopathy several neuropsychometric tests including those assisted by computers have been developed. Computerized psychometric tests uploaded into these handy devices have the potential to provide objective and prompt assessment of patients with hepatic encephalopathy. Lactulose and branched-chain amino acids are basic treatment modalities for encephalopathy in Japan. Oral administration of non-absorbable antibiotic rifaximin is a promising new adjunctive therapy based on control of blood ammonia levels and gut-derived infections in patients with decompensated cirrhosis. |