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    3rd Rot Journal

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    Hepatic encephalopathy (HE) is a neuropsychiatric disorder affecting up to 40% of cirrhosis patients, presenting with cognitive impairment and neuromuscular dysfunction. It contributes to repeated hospitalizations and severely impacts quality of life. HE can be classified as type A from acute liver failure, type B from portosystemic shunting, or type C as a cirrhosis complication. While ammonia and glutamine accumulation are implicated in type B and C pathophysiology, blood ammonia levels are generally not predictive of HE severity except in type A where levels over 200 μmol/L indicate risk of increased intracranial pressure and death.

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    3rd Rot Journal

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    2080315
    14 views1 page
    Hepatic encephalopathy (HE) is a neuropsychiatric disorder affecting up to 40% of cirrhosis patients, presenting with cognitive impairment and neuromuscular dysfunction. It contributes to repeated hospitalizations and severely impacts quality of life. HE can be classified as type A from acute liver failure, type B from portosystemic shunting, or type C as a cirrhosis complication. While ammonia and glutamine accumulation are implicated in type B and C pathophysiology, blood ammonia levels are generally not predictive of HE severity except in type A where levels over 200 μmol/L indicate risk of increased intracranial pressure and death.

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    journal and reflection

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    3rd rot journal

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    Hepatic encephalopathy (HE) is a neuropsychiatric disorder affecting up to 40% of cirrhosis patients, presenting with cognitive impairment and neuromuscular dysfunction. It contributes to repeated hospitalizations and severely impacts quality of life. HE can be classified as type A from acute liver failure, type B from portosystemic shunting, or type C as a cirrhosis complication. While ammonia and glutamine accumulation are implicated in type B and C pathophysiology, blood ammonia levels are generally not predictive of HE severity except in type A where levels over 200 μmol/L indicate risk of increased intracranial pressure and death.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    14 views1 page

    3rd Rot Journal

    Uploaded by

    2080315
    Hepatic encephalopathy (HE) is a neuropsychiatric disorder affecting up to 40% of cirrhosis patients, presenting with cognitive impairment and neuromuscular dysfunction. It contributes to repeated hospitalizations and severely impacts quality of life. HE can be classified as type A from acute liver failure, type B from portosystemic shunting, or type C as a cirrhosis complication. While ammonia and glutamine accumulation are implicated in type B and C pathophysiology, blood ammonia levels are generally not predictive of HE severity except in type A where levels over 200 μmol/L indicate risk of increased intracranial pressure and death.

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    JOURNAL READING WITH REFLECTION

    TITLE: Hepatic encephalopathy: current challenges and future prospects

    AUTHOR: Irashini Swaminathan, Mark Alexander Ellul, Timothy

    DATE PUBLISHED: March 22, 2018

    Hepatic encephalopathy (HE) is a hallmark of liver failure and affects up to 40% of patients with liver
    cirrhosis.1 It is defined as a multifactorial neuropsychiatric disorder presenting with a broad spectrum of cognitive impairment
    and neuromuscular dysfunction.1 HE is a significant contributor to repeated hospitalizations for patients with liver cirrhosis and
    severely impacts on the quality of life of both patients and caregivers.2 It is a marker of poor prognosis in cirrhotic patients,
    with reported rates of survival of only 36% at 1 year from its first presentation.3
    Chronic liver disease is the fifth most common cause of death in the UK, with the mortality expected to rise due to increase in
    cirrhosis caused by alcohol-related liver disease, chronic hepatitis C and nonalcoholic fatty liver disease. 4,5 Patients commonly
    present to primary and secondary care services with complications such as HE with or without a prior diagnosis of chronic
    liver disease. A milder form of the disorder, covert hepatic encephalopathy (CHE) or covert encephalopathy with subtle
    alterations of cognitive function, also exists.6 Although less severe, patients with CHE are at significant risk of interference
    with their quality of life, including increased falls, hospitalizations and progression to overt HE. 6–8
    HE can be classified as three separate clinical entities. Type A HE is due to acute liver failure, Type B due to
    portosystemic shunting (e.g., transjugular intrahepatic portosystemic shunting procedures) and Type C results as a
    complication of liver cirrhosis.9
    Type A HE is associated with an increased intracranial pressure that progresses rapidly and may lead to brain
    herniation. The pathophysiology of Type B and C HE is complex and remains under investigation. The main hypothesis
    involves the limited ability of the liver to effectively remove nitrogenous waste products, resulting in their accumulation and
    the deleterious effects on the brain due to portosystemic shunting.10,11 The key substrates implicated are ammonia and
    glutamine. Several studies have demonstrated that cirrhotic patients who had or were experiencing significant neuropsychiatric
    symptoms had elevated blood ammonia concentration.12,13 However, the levels were not predictive or consistent with the
    severity of HE.14,15 The exception is in type A HE, where Bernal et al have shown that a cut-off level of ammonia >200
    µmol/L16 is predictive of raised intracranial pressure and death.16,17

    Source: https://www.dovepress.com/hepatic-encephalopathy-current-challenges-and-future-prospects-
    peer-reviewed-fulltext-article-HMER

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