Clinical Manifestations and Therapy of Hepatic Encephalopathy

  • Juan Rodés
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 341)


Hepatic encephalopathy (HE) is a functional and generally reversible alteration of the central nervous system that appears in patients with acute and chronic liver disease. The pathogenesis of HE is not well understood (this aspect is deeply discussed in another chapter of this issue) although it has been suggested that the key mechanism is due to the inability of the liver to eliminate endogen and exogen products which are toxic to the brain. These substances reach the systemic blood stream because of the presence of hepatic failure, and the development of portosystemic shunts. Both mechanisms allow the intestinal blood to reach the brain without being cleared by the liver (1).


Hepatic Encephalopathy Hepatic Coma Acute Hepatic Failure Portal Systemic Encephalopathy Number Connection Test 
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  1. 1.
    Fraser, C. L., and Arieff, A. I., 1985, Medical progress: hepatic encephalopathy, New Engl J Med. 313:865–873.PubMedCrossRefGoogle Scholar
  2. 2.
    Victor, M., Adams, R. D., and Cole, M., 1965, The acquired (non-Wilsonian) type of chronic hepatocerebral degeneration, Medicine (Baltimore). 44:345–396.CrossRefGoogle Scholar
  3. 3.
    Rikkers, L., Jenko, P., Rudman, D., and Freides, O., 1978, Subclinical hepatic encephalopathy: detection, prevalence and relationship to nitrogen metabolism, Gastroenterology. 75:462–469.PubMedGoogle Scholar
  4. 4.
    Tarteer, R. E., Hegedns, A. M., and VanThiel, D. H., et al, 1984, Non-alcoholic cirrhosis associated with neuropsychological disfunction in the absence of overt evidence of hepatic encephalopathy, Gastroenterology 82:1421–1427.Google Scholar
  5. 5.
    Schomens, H., Hamster, W., and Blunck, H., et al, 1981, Latent portosystemic encephalopathy. I. Nature of cerebral functional defects and their effect on fitness to drive, Dig Dis Sci 26:622–630.CrossRefGoogle Scholar
  6. 6.
    Ferenci, P., Hepatic encephalopathy. Ed. Mclntyre, N., Benhamou, J.P., Bircher, J., Rizzetto, M., and Rodés, J., 1991, En: Oxford Textbook of Clinical Hepatology, Oxford. pp 471–484.Google Scholar
  7. 7.
    Mclntyre, N., 1991, Symptoms and signs of liver diseases. In: Oxford Textbook of Clinical Hepatology. Ed. Mclntyre, N., Benhamou, J. P., Bircher, J., Rizzetto, M., Rodés, J., Oxford. pp. 271–290.Google Scholar
  8. 8.
    Terés, J., Silva, G., Masana, J., and Rodés, J., 1987, Spectral analysis of the electroencephalogram predicts portal systemic encephalopathy in cirrhotic patients submitted to a distal spleno-renal shunt (abstract), J. Hepatol. 5(suppl):66.Google Scholar
  9. 9.
    Zenerolli, M. L., Pinelli, G., and Gollini, G., 1984 et al. Visual evokade potentials: a diagnostic tool for the assessment of hepatic encephalopathy, Gut. 25:291–299.CrossRefGoogle Scholar
  10. 10.
    Conn, H. O., and Lieberthal, M. H., 1979, The hepatic coma syndromes and lactulose, Williams and Wilkins. Baltimore.Google Scholar
  11. 11.
    Sherlock, S., 1987, Chronic portal systemic encephalopathy: update 1987, Gut. 28:1043–1048.PubMedCrossRefGoogle Scholar
  12. 12.
    Nelson, D. C., McGraw, W. R. G. Jr., and Horympa, A. M. Jr., 1983, Hypernatremia and lactulose therapy. JAMA. 249:1295–1298.PubMedCrossRefGoogle Scholar
  13. 13.
    Heredia, D., Caballeria, J., Arroyo, V., Ravelli, G., and Rodés, J., 1987, Lactitol versus lactulose in the treatment of acute portal systemic encephalopathy (PSE), A controlled trial, J. Hepatol. 4:293–2981.PubMedCrossRefGoogle Scholar
  14. 14.
    Rossi-Fanelli, F., Riggio, O., and Caniano, C., 1982, et al. Branched chain aminoacids vs lactulose in the treatment of hepatic coma: a controlled study, Dig Dis Sci. 27:475–480.CrossRefGoogle Scholar
  15. 15.
    Morgan, M. Y., 1990, Branched chain aminoacids in the management of chronic liver disease. Facts and fantasies, J. Hepatol. 11:135–141.CrossRefGoogle Scholar
  16. 16.
    Bansky, G., Meier, P. J., Riedered, E., Walser, H., Ziegler, W. H., and Smid, M., 1989, Effects of the benzidiazepine receptor antagonist flumazenil in hepatic ecephalopathy in humans, Gastroenterology. 97:744–750.PubMedGoogle Scholar
  17. 17.
    Morgan, M. Y., Hawley, K. E., and Strambuck, D., 1987, Lactitol vs lactulose in the treatment of chronic hepatic encephalopathy: a double-blind randomized, crossover study, J. Hepatol. 4:236–245.PubMedCrossRefGoogle Scholar
  18. 18.
    Potts, J. R., Henderson, J. M., and Millikan, W. J., Jr., 1984, et al. Restoration of portal venous perfusion and reversal of encephalopathy by balloon occlusion of portal-systemic shunt, Gastroenterology. 87:208–212.PubMedGoogle Scholar
  19. 19.
    Bismuth, H., Samuel, D., and Gugenheim, J., et al, 1987, Emergency liver transplantation for fulminant hepatitis, Ann Int Med. 107:337–341.PubMedGoogle Scholar
  20. 20.
    Grau, E., Felipo, V., Miñana, M. D., and Grisolia, S., 1992, Treatment of hyperammoniemia with carbamylglutamate in rats, Hepatology. 15:446–448.PubMedCrossRefGoogle Scholar
  21. 21.
    Bircher, J., and Sommer, W., 1992, Portal-systemic encephalopathy. In: Hepatobiliary diseases. Ed. Prieto, J., Rodés, J., and Shafritz, D. A., Springer-Verlag. Berlin Heidelberg, pp 417–426.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1993

Authors and Affiliations

  • Juan Rodés
    • 1
  1. 1.Liver Unit, Hospital Clínico y ProvincialUniversity of BarcelonaSpain

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