41. THE MERCK MANUAL, Sec. 4, Ch. 38, Clinical Features Of Liver Disease Other Symptoms And Signs Of Liver Disease. click here for navigation help.PortalSystemic Encephalopathy (hepatic encephalopathy; Hepatic Coma). http://www.merck.com/pubs/mmanual/section4/chapter38/38f.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 4. Hepatic And Biliary Disorders Chapter 38. Clinical Features Of Liver Disease Topics [General] Jaundice Hepatomegaly Portal Hypertension ... Other Symptoms And Signs Of Liver Disease Portal-Systemic Encephalopathy (Hepatic Encephalopathy; Hepatic Coma) A neuropsychiatric syndrome caused by liver disease and usually associated with portal-systemic shunting of venous blood. "Portal-systemic encephalopathy" is a more descriptive term of the pathophysiology than "hepatic encephalopathy" or "hepatic coma," but clinically all three are used interchangeably. Etiology Portal-systemic encephalopathy may occur in fulminant hepatitis caused by viruses, drugs, or toxins, but it more commonly occurs in cirrhosis or other chronic disorders when extensive portal-systemic collaterals have developed as a result of portal hypertension. The syndrome also follows portacaval shunt or similar portal-systemic anastomoses. In patients with chronic liver disease, encephalopathy is usually precipitated by specific, potentially reversible causes (eg, GI bleeding; infection; electrolyte imbalance, especially hypokalemia; alcoholic debauches) or iatrogenic causes (tranquilizers, sedatives, analgesics, diuretics).

42. PetPlace.com - Article: Hepatic Encephalopathy hepatic encephalopathy, by Dr. Arnold Plotnick. Vomiting; Diarrhea Diagnosishepatic encephalopathy is a syndrome and not a disease itself. http://petplace.netscape.com/articles/artShow.asp?artID=406

43. Hepatitis Central, Subclinical Hepatic Encephalopathy Impairs Daily Functioning Subclinical hepatic encephalopathy Impairs Daily Functioning ,Hepatitis CentralHome page is a source of information about the world epidemic Hepatitis C. http://hepatitis-central.com/hcv/symptoms/encephalopathy/subclinical.html

HEPATOLOGY, July 1998, p. 45-49, Vol. 28, No. 1 Original Articles Subclinical Hepatic Encephalopathy Impairs Daily Functioning Michael Groeneweg1, Juan C. Quero , Ilone De Bruijn , Ieneke J. C. Hartmann , Marie-louise Essink-bot , Wim C. J. Hop , and Solko W. Schalm From the Departments of Hepatogastroenterology, Public Health, and Biostatistics, Erasmus University Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. ABSTRACT INTRODUCTION Clinical manifestations of hepatic encephalopathy include a decreased intellectual function, personality disorders, an altered level of consciousness, and neuromuscular dysfunction. In addition to clinical manifest hepatic encephalopathy, a subclinical stage has been described, which cannot be detected through global clinical examination, but requires specific neuropsychological and neurophysiological examination. The prevalence of subclinical hepatic encephalopathy (SHE) is estimated to vary from 30% to 84% according to recent studies using appropriate methods. This variation in reported prevalence depends on the kind (psychometric or electrophysiological) and number of tests used, and the population (etiology and severity of the liver disease) tested.

44. A Review Of Congenital Portosystemic Shunting And Hepatic Encephalopathy A Review of Congenital Portosystemic Shunting and hepatic encephalopathy.Heptic encephalopathy is a neurologic disorder which may http://www.addl.purdue.edu/newsletters/1997/winter/cps.htm

Winter 1997 Newsletter document.write(doClock("M0","%20","D1",",%20","Y0")); A Review of Congenital Portosystemic Shunting and Hepatic Encephalopathy Heptic encephalopathy is a neurologic disorder which may develop in animals who have advanced liver disease and/or severe portosystemic shunting. Congenital porto-vascular anomalies, which allow portal blood to circumvent hepatic detoxification in affected dogs and cats, and chronic severe hepato-cellular disease with acquired intra- or extrahepatic portosystemic shunting (PSS) in dogs account for most of the cases of hepatic encephalopathy. Signalment and History Congenital PSS is more commonly seen in purebred (Yorkshire terriers and Miniature schnauzers) than in mix-breed dogs. Most animals are presented by 2 years of age, often by 6 months of age, and sporadically at any age. Owners' concerns are commonly related to neurologic, gastrointestinal, and/or urinary tract disorders. Furthermore, affected animals may have a history of stunted growth or failure to gain weight compared with unaffected littermates. Laboratory Evaluation Definitive diagnosis of a portosystemic shunt requires identification of the shunt by ultrasonography, contrast radiography, or exploratory laporatomy.

45. Health Ency.: Disease: Hepatic Encephalopathy hepatic encephalopathy. Causes and Risks. hepatic encephalopathy iscaused by disorders affecting the liver. These include disorders http://www.austin360.com/shared/health/adam/ency/article/000302.html

SEARCH: The Web Yellow Pages HOME Illustrated Health Encyclopedia Important notice Ency. home Disease H Hepatic encephalopathy Overview Symptoms Treatment Prevention Alternative names: Hepatic coma; Encephalopathy - hepatic Definition: A group of symptoms that may occur when there is damage to the brain and nervous system as a complication of liver disorders, characterized by various neurologic symptoms including changes in reflexes, changes in consciousness , and behavior changes that can range from mild to severe. Causes and Risks Hepatic encephalopathy is caused by disorders affecting the liver. These include disorders that reduce liver function (such as cirrhosis or hepatitis ) and conditions where blood circulation bypasses the liver. The exact cause of the disorder is unknown. The liver cannot properly metabolize and detoxify substances in the body. Accumulation of toxic substances causes metabolic abnormalities that lead to damage in the central nervous system (brain and spinal cord). One substance believed to be toxic is ammonia , which is produced by the body when proteins are digested, but normally is detoxified by the liver. Many other substances also accumulate in the body and damage the nervous system.

46. Doi:10.1226/0896031640 Hepatic Encephalopathy: Pathophysiology And Treatment (Hu Please click on the choices below to learn more about this item hepatic encephalopathyPathophysiology and Treatment Author(s) Butterworth, Roger F. and http://dx.doi.org/10.1226/0896031640

Please click on the choices below to learn more about this item: Hepatic Encephalopathy: Pathophysiology and Treatment Author(s): Butterworth, Roger F. and Layrargues, Gilles Pomier Format: Hardcover DOI: 10.1226/0896031640 Publisher's Catalog Page View Table of Contents By the Same Author(s) / Editor(s) Butterworth, Roger F. Animal Models of Neurological Disease, I: Neurodegenerative Diseases Animal Models of Neurological Disease, II: Metabolic Encephalopathies and Epilepsies Related Titles Neurology Adenosine and Adenosine Receptors Adrenergic Receptor Protocols Alpha-1 Adrenergic Receptors, The ... Email Humana Press Powered by Content Directions, Inc. (CDI) and the Digital Object Identifier (DOI)

47. Hepatic Encephalopathy- 1 Of 2 hepatic encephalopathy 1 of 2. hepatic encephalopathy is distinct from themore common brain fog that often experienced by people with HCV. http://archive.mail-list.com/hbv_research/msg04452.html

hbv_research archives Hepatic Encephalopathy- 1 of 2 Date: Mon, 6 Jan 2003 06:41:45 -0500 From hbv_research-list-owners@mail-list.com Subject Hepatic Encephalopathy- 1 of 2 mailto:HBV_Research-on@mail-list.com To unsubscribe, send a blank message to mailto:HBV_Research-off@mail-list.com To change your email address, send a message to mailto:HBV_Research-change@mail-list.com with your old address in the Subject: line Web Archive of all messages is at: http://dispatch.mail-list.com/archives/hbv_research Prev by Date: Hepatitis B in Children Next by Date: Hepatic Encephalopathy- 2 of 2 Return to Table of Contents:

48. Hepatic Encephalopathy- 2 Of 2 hepatic encephalopathy 2 of 2. Subject hepatic encephalopathy- 2 of 2. Theseverity of hepatic encephalopathy is measured on a five-point scale. http://archive.mail-list.com/hbv_research/msg04453.html

hbv_research archives Hepatic Encephalopathy- 2 of 2 Date: Mon, 6 Jan 2003 06:42:03 -0500 From hbv_research-list-owners@mail-list.com Subject Hepatic Encephalopathy- 2 of 2 mailto:HBV_Research-on@mail-list.com To unsubscribe, send a blank message to mailto:HBV_Research-off@mail-list.com To change your email address, send a message to mailto:HBV_Research-change@mail-list.com with your old address in the Subject: line Web Archive of all messages is at: http://dispatch.mail-list.com/archives/hbv_research Prev by Date: Hepatic Encephalopathy- 1 of 2 Next by Date: Hepatitis Tests Will Be Required for Some UK Health Workers Return to Table of Contents:

49. Clinical Manifestations And Diagnosis Of Hepatic Encephalopathy Clinical manifestations and diagnosis of hepatic encephalopathy CLINICAL MANIFESTATIONSLABORATORY TESTS • Ammonia Venous - Arterial DIAGNOSIS PSYCHOMETRIC http://www.uptodate.com/patient_info/topicpages/topics/Cirrhosi/11409.asp

Following is the full text, Medline abstracts and images of a topic review from UpToDate Some of the regular features found in UpToDate , such as drug information, links to related topics, and a simple but powerful search engine, are not incorporated here. USE OF PROFESSIONAL JUDGMENT Clinical manifestations and diagnosis of hepatic encephalopathy CLINICAL MANIFESTATIONS LABORATORY TESTS Ammonia Venous ... MAGNETIC RESONANCE SPECTROSCOPY Peter Ferenci, MD UpToDate performs a continuous review of over 290 journals and other resources. Updates are added as important new information is published. The literature review for UpToDate version 11.1 is current through December 2002; this topic was last changed on September 30, 2002. Hepatic encephalopathy describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of unrelated neurologic and/or metabolic abnormalities. The term implies that altered brain function is due to metabolic abnormalities, which occur as consequence of liver failure. The full reversibility of symptoms after improvement of liver function is considered to be direct proof of this causal relation. A generally accepted nomenclature could provide a solution to this debate and provide a standard for clinical studies. To achieve this goal, the World Organization of Gastroenterology (OMGE) commissioned a Working Party to reach a consensus in this area. A group of experts proposed a consensus statement at the 11th World Congress of Gastroenterology in Vienna in 1998 (

50. MEDLINE Abstract TI The prognostic significance of subclinical hepatic encephalopathy.AU - Hartmann IJ; Groeneweg M; Quero JC; Beijeman SJ; de http://www.uptodate.com/patient_info/topicpages/abstrcts/Abstrx5/2473300.htm

TI - The prognostic significance of subclinical hepatic encephalopathy. AU - Hartmann IJ; Groeneweg M; Quero JC; Beijeman SJ; de Man RA; Hop WC; Schalm SW SO - Am J Gastroenterol 2000 Aug;95(8):2029-34.

51. Volume 96, Number 7, July 2001 July 2001 Volume 96 , Number 7 Pages 1968 1976. hepatic encephalopathy Citethis article as Blei AT and Córdoba J. hepatic encephalopathy. http://www-east.elsevier.com/ajg/issues/9607/ajg3964fla.htm

Practice Guidelines July 2001 Volume , Number Pages Hepatic Encephalopathy Andres T. Blei a rdoba b and The Practice Parameters Committee of the American College of Gastroenterology Cite this article as: a Department of Medicine, Lakeside VA Medical Center and Northwestern University, Chicago, Illinois b Unidad de Hepatologia, Hospital Vall d'Hebron and Autonomous University of Barcelona, Barcelona, Spain Preamble Introduction Hepatic encephalopathy (HE) may be defined as a disturbance in central nervous system function because of hepatic insufficiency. This broad definition reflects the existence of a spectrum of neuropsychiatric manifestations related to a range of pathophysiological mechanisms. Present in both acute and chronic liver failure, these neuropsychiatric manifestations are potentially reversible. Clinical Considerations Pathophysiology The main tenet of all theories of the pathogenesis of HE is firmly accepted: nitrogenous substances derived from the gut adversely affect brain function. These compounds gain access to the systemic circulation as a result of decreased hepatic function or portal-systemic shunts. Once in brain tissue, they produce alterations of neurotransmission that affect consciousness and behavior. Abnormalities in glutamatergic, serotoninergic, -aminobutyric acid-ergic (GABA-ergic), and catecholamine pathways, among others, have been described in experimental HE (

52. Tampere University: Dissertation Information Author, Hanna Klinowska. Title, EFFECT OF EXPERIMENTAL hepatic encephalopathy ONSTRIATAL AND CORTICAL GLUTAMATERGIC MODULATION OF DOPAMINERGIC NEUROTRANSMISSION. http://acta.uta.fi/english/teos.phtml?6672

53. Hepatic Encephalopathy hepatic encephalopathy a complication of liver failure that results from largeamounts of ammonia that accumulate in the brain; symptoms include euphoria http://www.hepcchallenge.org/manual/glossary/Hepatic_encephalopathy.htm

Hepatic encephalopathy - a complication of liver failure that results from large amounts of ammonia that accumulate in the brain; symptoms include euphoria, depression, confusion, slurred speech, abnormal sleeping patterns, incoherent speech, tremors, rigid muscles, and eventually coma

54. Publications 249) C. Zwingmann, D. Leibfritz, A. Hazell Role of manganese in hepatic encephalopathyAdv. in hepatic encephalopathy and Nitrogen Metabolism. http://www.chemie.uni-bremen.de/leibfritz/pubs.html

Publications The documents (underlined numbers) are stored in .pdf format. Use e.g. Acrobat Reader or GSview 250) V. Brezova, M. Valko, M. Breza, H. Morris, J. Telser, D. Dvoranova, K. Kaiserova, L. Varecka, M. Mazur, D. Leibfritz Role of radicals and singlet oxygen in photoactivated DNA cleavage by the anticancer drug camptothecin: An electron paramagnetic resonance study. J.Phys.Chem., in press C. Zwingmann, D. Leibfritz, A. Hazell Role of manganese in hepatic encephalopathy Adv. in Hepatic Encephalopathy and Nitrogen Metabolism. EA Jones, RAFM Chamuleau and AJ Meijer, eds., Kluwer, Dordrecht, Nederlands, in press (2003) C. Zwingmann, T. Shokati, R.F. Butterworth, D. Leibfritz, Use of NMR spectroscopy for the study of ammonia metabolism in astrocytes and neurons: Role of glutamine synthesis in astrocytes Adv. in Hepatic Encephalopathy and Nitrogen Metabolism. EA Jones, RAFM Chamuleau and AJ Meijer, eds., Kluwer, Dordrecht, Nederlands, in press (2003) C. Zwingmann, N. Chatauret, D. Leibfritz, R.F. Butterworth Brain energy metabolism in acute liver failure: Studies using NMR spectroscopy.

55. Welcome To ENH.org - Health Encyclopedia: Hepatic Encephalopathy hepatic encephalopathy. Causes, incidence, and risk factors Hepaticencephalopathy is caused by disorders affecting the liver. These http://www.enh.org/Encyclopedia/ency/article/000302.asp

Disease Reference Injury Reference Test Reference Nutrition Reference ... Symptoms Reference Hepatic encephalopathy Disease Injury Nutrition Poison ... Z Definition: A group of symptoms that may occur when there is damage to the brain and nervous system as a complication of liver disorders, characterized by various neurologic symptoms including changes in reflexes, changes in consciousness , and behavior changes that can range from mild to severe. Alternative Names: Hepatic coma; Encephalopathy - hepatic Causes, incidence, and risk factors: Hepatic encephalopathy is caused by disorders affecting the liver. These include disorders that reduce liver function (such as cirrhosis or hepatitis ) and conditions where blood circulation bypasses the liver. The exact cause of the disorder is unknown. The liver cannot properly metabolize and detoxify substances in the body. Accumulation of toxic substances causes metabolic abnormalities that lead to damage in the central nervous system (brain and spinal cord). One substance believed to be toxic is ammonia , which is produced by the body when proteins are digested, but normally is detoxified by the liver. Many other substances also accumulate in the body and damage the nervous system.

56. ETenet - Library . hepatic encephalopathyis the result of biochemical abnormalities associated with liver failure.......hepatic encephalopathy. Definition. (Back to Top). http://www.etenet.com/Apps/Library/Corporate.asp?ID=331

57. Health Library Find Information On Hepatic Encephalopathy At Find information on hepatic encephalopathy at MerckSource. Learn more aboutHepatic hepatic encephalopathy. Definition A group of symptoms http://www.mercksource.com/pp/us/cns/cns_hl_adam.jspzQzpgzEzzSzppdocszSzuszSzcns

58. Disposition Of Venlafaxine Enantiomers In Rats With Hepatic Title Disposition of venlafaxine enantiomers in rats with hepatic encephalopathyafter chronic drug treatment. Authors Wikell, Cecilia http://eprints.lub.lu.se/archive/00010448/

59. Pathogenesis Of Hepatic Encephalopathy... Implicaciones en el tratamiento Rev Gastroenterol Mex 1995; 60(3) 159168.Pathogenesis of hepatic encephalopathy. Implications on therapy. ABSTRACT. http://www.imbiomed.com.mx/Gastro/Gav60n3/english/Zge53-05.html

García-Compean D, Michel H Fisiopatogenia de la encefalopatía hepática cirrótica. Implicaciones en el tratamiento Rev Gastroenterol Mex Pathogenesis of hepatic encephalopathy. Implications on therapy ABSTRACT Background: Hepatic encephalopathy (HE) is a neuropsychologic syndrome associated with multifactorial metabolic disruptions. Several physiopathogenic theories have been proposed. Objectives: To review the most important theories (ammonia, mercaptans, short chain Jatty acids, false neurotransmitters, gamma amminobutyric acid, endogenous benzodiazepines) and to analize the different therapeutic modalities derivedfrom these theories. Methods: An intensive bibliographic review was carried out using Med Line and Current Contents data base. Randomized therapeutic trials published in the last ten years were particularly analyzed. Results: From all theories proposed, the revised ammonia theory better explains pathogenesis of HE based on the information about efficacy of antiammonia agents. Authors propose a theory in order to explain the effect of ammonia and serotonin in neurotrasmission, particularly excitatory glutamatergic neurotransmission. Conclusions: It seems that ammonia has a predominant role in pathogenesis of HE. Some other agents may be involved but its nature is not actually defined. Glutamatergic neurotransmission un HE has been recently studied.

60. HELICOBACTER PYLORI AS A RISK FACTOR FOR CHRONIC HEPATIC ENCEPHALOPATHY HELICOBACTER PYLORI AS A RISK FACTOR FOR CHRONIC hepatic encephalopathy.Kabil SM, Amany Lashin, Younis YS and *ElDebakey F. Departments http://www.health.egnet.net/hepatology/HELICOBACTER PYLORI .html

HELICOBACTER PYLORI AS A RISK FACTOR FOR CHRONIC HEPATIC ENCEPHALOPATHY. Kabil SM, Amany Lashin, Younis YS and *El-Debakey F. Departments of Hepatology, Abstract Helicobacter pylori (H.pylori) positive (Group-A No. 30) and H.pylori negative (Group-B No. 20). Ten cirrhotic patients without HE nor H.pylori were chosen as cirrhotic control group, (Group-C). Groups-A and B were treated for HE. Group-A was also treated with anti- H.pylori triple therapy regimen. Both intragastric and plasma levels of ammonia were assessed before and after treatment. Eradication of H.pylori H.pylori has a strong association with ammonia levels in patients with chronic HE, so strategy of HE management should include H.pylori diagnosis and eradication to improve the net result of therapy of C, HE management.

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