Medicinski vjesnik, Vol. 42 No. (1-2), 2010.
Pregledni rad
Hepatic encephalopathy
Pavo Filaković
Sažetak
Hepatic encephalopathy is reversible neurologic and psychiatric complication due to acute or chronic liver disease and it is caused by accumulation of neurotoxins from small intestine which cannot be degraded by the liver. The psychiatric signs of encephalopathy are: altered level of consciousness, changes in personality, intellectual alterations and speech transformations. Characteristic neurologic features of encephalopathy are flapping tremor (asterixis) and hyperreflexion. The illness severity is graded from 0 to 4, that is, from subclinical, over mild, severe to extremely severe stage. Clinical variations of hepatic encephalopathy are classified as: the preclinical type, acute type, chronic type and hepatocerebral degeneration. Disease pathogenesis resides on three principal postulates: 1) causative metabolic toxins (nitrogen-containing compounds) probably originated from the intestine; 2) these toxic substances, due to portal hepatic and portacaval shunts, bypass the liver without undergoing metabolisation; 3) toxins than pass the blood-brain barrier and exert direct or indirect neurotoxic effect on central nervous system. Hepatic encephalopathy treatment strategy goes three-way: 1) elimination of precipitating factors; 2) application of procedures and agents for reducing ammonia and other toxic substances in circulation; 3) use of experimental therapeutic procedures. Disease prognosis depends upon stage of liver disease, the type and degree of functional damage and possible treatments of various precipitating factors (bleeding, infection, incorrect diet, overdose, diuretics etc.)
Ključne riječi
Hepatic encephalopathy; Liver failure
Hrčak ID:
191877
URI
Datum izdavanja:
1.12.2010.
Posjeta: 10.147 *