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Hepatic Encephalopathy: Pathophysiology—Brain

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Diagnosis and Management of Hepatic Encephalopathy

Abstract

In liver disease, a number of systemic pathogenic factors are responsible for the onset and progression of hepatic encephalopathy. A reduced capacity of the liver to clear gut-derived ammonia leads to an increase in blood ammonia and neurotoxicity. Portal-systemic shunting as well as a reduction in muscle quality and/or muscle mass loss further increase the risk of developing hyperammonemia. Systemic oxidative stress and inflammation together with hyperammonemia can trigger cognitive decline. These factors can cross the blood-brain barrier and affect the brain directly or alter the permeability and signaling across the blood-brain barrier. Long considered a reversible disorder, there is ample amount of evidence demonstrating that repeated episodes of overt HE can prompt neuronal cell injury/death leading to irreversibility. This chapter describes a patient who embarks on the continuum of HE, describing precipitating factors involved in the pathogenesis of cognitive decline.

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Authors and Affiliations

  1. CHUM, Université de Montréal, Montréal, Québec, Canada

    Julien Bissonnette M.D.

  2. CRCHUM, Université de Montréal, Montréal, Québec, Canada

    Christopher F. Rose Ph.D.

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  1. Julien Bissonnette M.D.
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Correspondence to Christopher F. Rose Ph.D. .

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  1. McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia, USA

    Jasmohan S. Bajaj

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Bissonnette, J., Rose, C.F. (2018). Hepatic Encephalopathy: Pathophysiology—Brain. In: Bajaj, J. (eds) Diagnosis and Management of Hepatic Encephalopathy. Springer, Cham. https://doi.org/10.1007/978-3-319-76798-7_2

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