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Hepatische Enzephalopathie

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Zusammenfassung

Die hepatische Enzephalopathie (HE) ist eine neuropsychiatrische Komplikation akuter und chronischer Lebererkrankungen. Ursache ist eine komplexe, metabolisch induzierte und damit potenziell reversible Funktionsstörung des Gehirns. Voraussetzung für die Diagnose einer HE ist der Nachweis einer Funktionsstörung des zentralen Nervensystems bei gleichzeitig bestehender Leberfunktionsstörung und sicherem Ausschluss einer neurologischen oder psychiatrischen Erkrankung anderer Ätiologie. Die Diagnose einer HE wird rein klinisch gestellt und umfasst ein weites Spektrum neuropsychiatrischer Symptome unterschiedlicher Schweregrade. Die ergänzende Zusatzdiagnostik beinhaltet labormedizinische Methoden, bildgebende Verfahren und neurophysiologische Zusatzuntersuchungen. Die Therapie der HE besteht im Wesentlichen aus der Behandlung und zukünftigen Vermeidung auslösender Faktoren, der Modulation metabolischer Prozesse sowie ultima ratio der Lebertransplantation. Die Prognose hängt von der Art und dem Verlauf der hepatischen Grunderkrankung ab.

Summary

Hepatic encephalopathy (HE) is a neuropsychiatric complication of acute and chronic liver disease. Its etiology and pathogenesis are thought to be a complex, metabolically induced, and therefore potentially reversible disturbance in brain functions. The diagnosis is based on demonstrating both a disorder of the central nervous system and a concomitant liver disease as well as the exclusion of any neurological or psychiatric disorder of other etiology. The diagnosis of HE is clinical and displays a wide spectrum of neuropsychiatric symptoms in different degrees of severity. Ancillary diagnostic workup includes laboratory tests, neuroimaging, and neurophysiological exams such as electroencephalography and evoked potentials. The therapy of HE mainly consists of treatment and avoidance of any precipitating conditions such as high protein intake, infections, and gastrointestinal bleeding. Other therapeutic approaches modulate metabolic processes such as ammonium synthesis and excretion, formation of neurotransmitters, and as a last resort liver transplantation. The prognosis depends ultimately on the course of the liver disease.

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Authors and Affiliations

  1. Neurologische Klinik, Universitätsklinikum Heidelberg

    P. D. Schellinger, Ch. Klingmann & H. M. Meinck

  2. Abt. Neuroradiologie, Universitätsklinikum Heidelberg

    M. K. Hartmann

  3. HNO-Klinik, Universitätsklinikum Heidelberg

    Ch. Klingmann

  4. Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120 , Heidelberg

    P. D. Schellinger

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  1. P. D. Schellinger
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Correspondence to P. D. Schellinger.

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Schellinger, P.D., Hartmann, M.K., Klingmann, C. et al. Hepatische Enzephalopathie. Nervenarzt 74, 1078–1087 (2003). https://doi.org/10.1007/s00115-003-1579-1

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