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Encephalopathy Associated with Liver Disease

  • Conference paper
Brain Failure

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 9))

  • 68 Accesses

Abstract

Hepatic encephalopathy (HE) is a reversible clinical syndrome of which the manifestations range from a slight alteration in mental status to deep coma with a lack of response to painful stimuli. The degree to which symptoms of encephalopathy are seen within an individual patient appears to be directly related to the speed of development of the hepatic failure; thus a paracetamol overdose may proceed from mild disorientation to grade IV coma over the course of several hours.

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References

  1. Zieve L (1981) Synergism among toxic factors and other endogenous abnormalities in hepatic encephalopathy. In: Brunner G, Schmidt FW (eds) Artificial liver support. Springer, Berlin Heidelberg New York, pp 18–24

    Chapter  Google Scholar 

  2. Zieve L, Doizaki WM, Lyftot C (1984) Brain methanethiol and ammonia concentrations in experimental hepatic coma induced by injections of various combinations of these substances. J Lab Clin Med 104:655–664

    PubMed  CAS  Google Scholar 

  3. Livingstone AS, Potvin M, Goresky CA, et al (1977) Changes in the blood brain barrier in hepatic coma after hepatectomy in the rat. Gastroenterology 73:697–704

    PubMed  CAS  Google Scholar 

  4. Zaki AEO, Ede R, Davis M, Williams R (1984) Experimental studies of blood brain barrier permeability. Hepatology 4:359–363

    Article  PubMed  CAS  Google Scholar 

  5. Zaki AEO, Wardle EN, Canalese J, Ede RJ, Williams R (1983) Potential toxins of acute liver failure and their effects on blood brain barrier permeability. Experientia 39:988–991

    Article  PubMed  CAS  Google Scholar 

  6. Lo WD, Enms SR, Goldstein GW, McNeely DL, Betz A (1987) The effects of galactosamine induced hepatic failure upon blood brain barrier permeability. Hepatology 7:3:452-456

    Article  Google Scholar 

  7. Knudsen GM, Poulsen HE, Poulson OB (1988) Blood brain permeability in galactosamine induced hepatic encephalopathy: No evidence for increased GABA transport. J Hepatol 6:187–192

    Article  PubMed  CAS  Google Scholar 

  8. Horowitz ME, Schafer DF, Nolnar P, et al (1983) Increased blood brain transfer in the rabbit model of acute liver failure. Gastroenterology 84:1003–1011

    PubMed  CAS  Google Scholar 

  9. Dahl DR (1968) Short chain fatty acid inhibition of rat brain Na/K adenosine triphosphatase. J Neurochem 15:815–820

    Article  PubMed  CAS  Google Scholar 

  10. Quarforth G, Ahmed K, Zieve L (1976) Action of methanethiol on membrane Na/K AT-Pase of rat brain. Bioch Pharmacol 25:1039–1044

    Article  Google Scholar 

  11. Seda HWM, Gove CD, Hughs RD, Williams R (1984) Inhibition of partially purified rat brain Na/K ATPase by bile acids, phenolic acids and endotoxin. Clin Sci 66:415–420

    PubMed  CAS  Google Scholar 

  12. Rehncrona S, Roxi I, Siesjö BK (1980) Excessive cellular acidosis: An important mechanism of neuronal damage in the brain. Acta Physiol Scand 110:435–437

    Article  PubMed  CAS  Google Scholar 

  13. Seda HWM, Hughes RD, Gove CD, Williams R (1984) Inhibiton of rat brain Na/K ATPase activity by serum from the patient with fulminant hepatic failure. Hepatology 4:74–79

    Article  PubMed  CAS  Google Scholar 

  14. Seda HWM, Hughes RD, Gove CD, Williams R (1984) Removal of inhibitors of brain Na/K ATPase by haemoperfusion in fulminant hepatic failure. Artific Organs 8:174–178

    Article  CAS  Google Scholar 

  15. Ede R, Gove CD, Hughes RD, Marshall W, Williams R (1987) Reduced brain Na/K ATPase activity in rats with galactosamine induced hepatic failure; a relationship to encephalopathy and cerebral oedema. Clin Sci 72:365–371

    PubMed  CAS  Google Scholar 

  16. Lockwood AH, McDonald JM, Reiman RE, et al (1979) The dynamics of ammonia metabolism in man: Effects of liver disease and hyperammonemia. J Clin Invest 63:449–460

    Article  PubMed  CAS  Google Scholar 

  17. Zieve L (1987) Pathogenesis of hepatic encephalopathy. Metabolic Brain Disease 2; 3:147–165

    Article  Google Scholar 

  18. Pappas SC, Ferenci P, Schafer DF, et al (1984) Visual evoked responses in a rabbit model of hepatic encephalopathy. II Comparison of hyperammonemic encephalopathy: post ictal coma and coma induced by synergistic neurotoxins. Gastroenterol 86:546–551

    CAS  Google Scholar 

  19. Ferenci P, Pappas SC, Jones EA (1984) Neurotransmitter receptor changes in experimental hyperammonemia in the rabbit. In: Advances in hepatic encephalopathy and urea cycle diseases. Karger, Basel, pp 368–372

    Google Scholar 

  20. O’Keefe SJD, Abraham R, El-Zayadi A, Marshall W, Davis M, Williams R (1981) Increased plasma tyrosine concentrations in patients with cirrhosis and fulminant hepatic failure associated with increased plasma tyrosine flux and reduced hepatic oxidative capacity. Gastroenterology 1017–1024

    Google Scholar 

  21. James JH, Jeppson B, Ziparo V, Fischer JE (1979) Hyperammonemia, plasma amino acid imbalance and blood brain amino acid transport: A unified theory of portal systemic encephalopathy. Lancet 1:772–775

    Article  Google Scholar 

  22. Zieve L, Zoizaki WM, Derr RF (1979) Reversal of ammonia coma in rats by L-Dopa: A peripheral effect. Gut 20:28–38

    Article  PubMed  CAS  Google Scholar 

  23. Fahey JC (1957) Toxicity and blood ammonia rise resulting from intra-venous amino acid administration in man. The protective effect of L-arginine. J Clin Invest 36:1647–1655

    Article  PubMed  CAS  Google Scholar 

  24. Rossi-Fanelli F, Freund H, Krause R, et al (1982) Induction of coma in normal dogs by infusion of amino acids, and its prevention by the addition of branched chain amino acids. Gastroenterology 83:664–671

    PubMed  CAS  Google Scholar 

  25. Borg J, Waiter JM, Schleinger JL, et al (1982) Neurotransmitter modifications in human cerebrospinal fluid and serum during hepatic encephalopathy. J Neurol Sci 57:343–356

    Article  PubMed  CAS  Google Scholar 

  26. McLain CJ, Zieve L, Doizaki WM, Gilberstadt S, Onstad GR (1980) Blood methanethiol in alcoholic liver disease with and without encephalopathy. Gut 21:318–323

    Article  Google Scholar 

  27. Derr RF, Zieve L (1982) Methanethiol and fatty acids depress urea synthesis by the isolated rat perfused liver. J Lab Clin Med 100:585–592

    PubMed  CAS  Google Scholar 

  28. Zeneroli ML, Ventura E, Baraldi M, et al (1982) Visual evoked responses in encephalopathy induced by galactosamine, ammonia, dimethylsulphide and octanoic acid. Hepatology 2:532–538

    Article  PubMed  CAS  Google Scholar 

  29. Zieve L (1985) Encephalopathy due to short and medium chain fatty acids. In: McCandless CW (ed) Cerebral energy metabolism and metabolic encephalopathy. Plenum Press, New York, pp 163–177

    Google Scholar 

  30. Ferenci P, Covell D, Schafer DF, et al (1983) Metabolism of the inhibitory neurotransmitter GABA in a rabbit model of fulminant hepatic failure. Hepatology 3:507–512

    Article  PubMed  CAS  Google Scholar 

  31. Schafer DF, Pappas SC, Brody LE, et al (1984) Visual evoked responses in a rabbit model of hepatic encephalopathy I: Sequential changes and comparisons with drug induced comas. Gastroenterology 86:540–545

    PubMed  CAS  Google Scholar 

  32. Basset ML, Mullen KD, Schlotz B, et al (1985) Increased brain GABA uptake in pre-coma encephalopathy in the rabbit model of fulminant hepatic failure. Hepatology 5:1032–1036

    Google Scholar 

  33. O’Fallen JV, Brosemer RW, Harding JW (1981) The Na/K ATPase: A plausible trigger for voltage independent release of cytoplasmic neurotransmitters. J Neurochem 36:369–378

    Article  Google Scholar 

  34. Roy S, Pomier Layrageus G, Butterworth RF, Hoest PM (1988) Hepatic encephalopathy in cirrhotic and portocaval shunted dogs: Lack of changes in brain GABA uptake, brain GABA levels, brain glutamic acid decarboxylase activity and brain post synaptic GABA receptors. Hepatology 8:845–849

    Article  PubMed  CAS  Google Scholar 

  35. Schafer DF, Fowler JM, Munson, et al (1983) Gamma aminobutyric acid and benzodiazepam receptors in an animal model of fulminant hepatic failure. J Lab Clin Med 102:870–880

    PubMed  CAS  Google Scholar 

  36. Ferenci P, Pappas SC, Munson PJ, et al (1984) Changes in the status of neurotransmitter receptors in the rabbit model of hepatic encephalopathy. Hepatology 4:186–191

    Article  PubMed  CAS  Google Scholar 

  37. Levy LJ, Losowsky MS (1987) Evidence for gamma aminobutyric acid as the inhibitor of gamma aminobutyric acid binding in the plasma of humans with liver disease and hepatic encephalopathy. Clin Sci 73:531–534

    PubMed  CAS  Google Scholar 

  38. Mullen KD, Martin JV, Bassett ML, et al (1986) Hepatic encephalopathy: A syndrome modulated by an endogenous benzodiazepine ligand. Hepatology 6:1221–1224

    Article  Google Scholar 

  39. Baraldi M, Zenerloi ML, Ventura E, et al (1984) Supersensitivity of benzodiazepine receptors in hepatic encephalopathy due to fulminant hepatic failure in the rat: reversal by a benzodiazepine antagonist. Clin Sci 67:167–175

    PubMed  CAS  Google Scholar 

  40. Bassett ML, Mullen KD, Skolnick P, Jones EA (1987) Amelioration of hepatic encephalopathy by pharmacological antagonism of the GABA-benzodiazepine receptor complex in a rabbit model of fulminant hepatic failure. Gastroenterology 93:1069–1077

    PubMed  CAS  Google Scholar 

  41. Gammal SH, Geller D, Skolnick P, et al (1987) Unequivocal amelioration of hepatic encephalopathy by benzodiazepine antagonists in a rabbit model of fulminant hepatic failure. J Hepatol 4:517–520

    Google Scholar 

  42. Scollo-Lavizzar G, Steinmann E (1985) Reversal of hepatic coma by benzodiazepine antagonist (Ro 15-1788). Lancet 1:1320–1324

    Google Scholar 

  43. Bansky G, Meier PJ, Reiderer E, Walser H, Zeigler WH, Schmidt M (1987) Effect of a benzodiazepine antagonist in hepatic encephalopathy. Hepatology 7:1103–1105

    Google Scholar 

  44. Grimm G, Ferenci P, Katzenschlager L, et al (1988) Improvements in hepatic encephalopathy treated with Flumazenil. Lancet 2:1392–1394

    Article  PubMed  CAS  Google Scholar 

  45. Olsen RW, Young J, King RG, Duber SA, Stauber GB, Ransom RW (1986) Barbiturate and benzodiazepine modulation of the GABA receptor and function. Life Sci 39:1969–1976

    Article  PubMed  CAS  Google Scholar 

  46. Bonetti EP, Pieri L, Cumm R, et al (1988) Benzodiazepine antagonist Ro 15-1788: neurological and hevaioural effects. Psychopharmacology 78:8–18

    Article  Google Scholar 

  47. Basile AS, Gammal SH, Mullen KD, et al (1988) Differential responsiveness of cerebellar Purkinje neurons to GABA and benzodiazepine ligands in an animal model of hepatic encephalopathy. J Neuro Sci 8:2414–2421

    CAS  Google Scholar 

  48. Wildmann J, Mohler H, Vetter, et al (1987) Diazepam and N-desmethyldiazepam are found in rat brain and adrenal and may be of plant origin. J Neural Transm 70:383–398

    Article  PubMed  CAS  Google Scholar 

  49. Sangameswaran L, Fales HM, Freidrich P, et al (1986) Purification of a benzodiazepine from bovine brain and benzodiazepine-like immunoreactivity in human brain. Proc Natl Sci USA 83:9236–9340

    Article  CAS  Google Scholar 

  50. Mullen KD, Szauter KM, Galloway PG, et al (1986) CSF of patients with hepatic encephalopathy contains significant benzodiazepine binding activity. Correlation with post mortem cortical benzodiazepine binding studies. Hepatology 7:1103–1106

    Google Scholar 

  51. Gimson AES, Braude S, Mellon PJ, et al (1982) Earlier charcoal haemoperfusion in fulminant hepatic failure. Lancet 2:681–683

    Article  PubMed  CAS  Google Scholar 

  52. Ede R, Gimson AES, Bihari D, Williams R (1986) Controlled hyperventilation in the prevention of cerebral oedema in fulminant hepatic failure. J Hepatol 2:43–51

    Article  PubMed  CAS  Google Scholar 

  53. Canalase J, Gimson AES, Davis C, et al (1982) Controlled trial of dexamethasone and mannitol for the cerebral oedema of fulminant hepatic failure. Gut 23:625–629

    Article  Google Scholar 

  54. Bihari D, Gimson AES, Lindridge J, Williams R (1984) Lactic acidosis in fulminant hepatic failure. Crit Care Med 12:255–257

    Google Scholar 

  55. Hand MA, Silk DB, Williams R (1978) Prognostic value of oculovestibular reflex in fulminant hepatic failure. Br Med J 1:1029–1030

    Article  Google Scholar 

  56. Hughes R, Williams R (1986) Clinical experience with charcoal and resin haemoperfusion. Semin Liver Dis 6:164–173

    Article  PubMed  CAS  Google Scholar 

  57. O’Grady J, Gimson AES, O’Brien CJ, et al (1988) Controlled trials of charcoal haemoperfusion and prognostic factors in fulminant hepatic failure. Gastroenterology 94:1186–1192

    PubMed  Google Scholar 

  58. Davenport A, Will EJ, Losowsky MS, Swindels S (1987) Continuous arterio-venous haemofiltration in patient with hepatic encephalopathy and renal failure. Br Med J 295:1028

    Article  CAS  Google Scholar 

  59. Hanid MA, McKenzie RL, Jenner RE, et al (1974) Intracranial pressure in pigs with surgically induced liver failure. Gastroenterology 76:123–131

    Google Scholar 

  60. Skinhoj E, Paulson OB (1969) Carbon dioxide and cerebral circulatory control. Arch Neurol 20:249–252

    Article  PubMed  CAS  Google Scholar 

  61. Ede R, Williams R (1986) Hepatic encephalopathy and cerebral oedema. Sem Liver Dis 6:2:107-118

    Article  Google Scholar 

  62. Stanley NN, Salisbury BG, McHenry LC, Cherniac NS (1975) Effect of liver failure on the response of ventilation and cerebral circulation to carbon dioxide in man and in the goat. Clin Sci Mol Med 49:157–169

    PubMed  CAS  Google Scholar 

  63. Ede R, Gimson AES, Bihari D, Williams R (1986) Controlled hyperventilation in the prevention of cerebral oedema in fulminant hepatic failure. J Hepatol 2:43–51

    Article  PubMed  CAS  Google Scholar 

  64. Clasen RA, Pandolfi S, Lang I, Casey D (1974) Experimental study of relationship of fever to cerebral edema. J Neurosurg 41:576–581

    Article  PubMed  CAS  Google Scholar 

  65. Michenfelder JD, Theye RA (1968) Hypothermia: Effect on canine brain and whole body metabolism. Anesthesiology 29:1107–1112

    Article  PubMed  CAS  Google Scholar 

  66. Ede R, Gimson AES, Canalase J, Williams R (1982) Cerebral oedema and monitoring of intracranial pressure in fulminant hepatic failure. Gastroenterol Jpn 17:163–176

    PubMed  CAS  Google Scholar 

  67. Smith AC, Morque JJ (1976) Anaesthetics and cerebral edema. Anesthesiology 45:64–72

    Article  PubMed  CAS  Google Scholar 

  68. Desmopoulos HB, Fiamm ES, Seligman ML, et al (1977) Antioxidant effect of barbiturates in model membranes undergoing free radical damage. In: Ingvar DH, Lassen NA (eds) Cerebral blood flow VIII. Cerebral function metabolism and circulation. Copenhagen, Munksgaard, pp 152–153

    Google Scholar 

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Authors
  1. J. Wendon
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  2. R. Williams
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Editor information

Editors and Affiliations

  1. Intensive Care Unit, Guy’s Hospital, St. Thomas Street, London, SE1 9RT, UK

    David Bihari

  2. Department of Neuropsychiatry, Walter Reed Army Institute of Research, Washington, DC, 20307, USA

    John W. Holaday

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© 1989 Springer-Verlag Berlin Heidelberg

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Wendon, J., Williams, R. (1989). Encephalopathy Associated with Liver Disease. In: Bihari, D., Holaday, J.W. (eds) Brain Failure. Update in Intensive Care and Emergency Medicine, vol 9. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-83929-0_9

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  • DOI: https://doi.org/10.1007/978-3-642-83929-0_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-51655-2

  • Online ISBN: 978-3-642-83929-0

  • eBook Packages: Springer Book Archive

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