61. Health Content Encyclopedia Article Hepatic Encephalopathy hepatic encephalopathy Causes and Risk. hepatic encephalopathy is causedby disorders affecting the liver. These include disorders http://www.baptisteast.com/adamcontent/ency/article/000302.asp

62. Granum: Information Of The Publication EFFECT OF EXPERIMENTAL hepatic encephalopathy ON STRIATAL AND CORTICAL GLUTAMATERGICMODULATION OF DOPAMINERGIC NEUROTRANSMISSION Acta Universitatis Tamperensis http://granum.uta.fi/cgi-bin/book.cgi?6672

63. FOCUS HCVNEWS: Liver Dialysis Appears Effective For Refractory Hepatic Encephal Liver Dialysis Appears Effective for Refractory hepatic encephalopathy, QuantumMedia Group's Focus On Hepatitis C International Website, 524hcvnw.html http://www.focusonhepc.com/hcvnews/524hcvnw.html

Close Window Webmaster note: Either your browser does not support Javascript or it is currently disabled. Liver Dialysis Appears Effective for Refractory Hepatic Encephalopathy "We've seen encouraging results in studies on three similar viruses including West Nile virus, HCV and Calicivirus. Norwalk virus, the virus currently plaguing the cruise ship industry, is another single–stranded RNA virus from the same family." Boston, MA Medscape Medical News In a prospective study of 18 patients with episodic hepatic encephalopathy (EHE), 16 showed significant improvement in mental status within two days, according to Donald J. Hillebrand, MD, associate professor of medicine, chief of hepatology, and medical director of liver transplantation at Loma Linda. "Charcoal–based hemodiabsorption utilizing LDU treatments are able to safely, rapidly and effectively resolve EHE failing to respond to 24 hours of appropriate medical management in patients with advanced cirrhosis," write Dr. Hillebrand and colleagues in their study abstract. "Liver dialysis is a completely artificial device that utilizes charcoal to selectively bind toxins that build up in the setting of liver failure," Dr. Hillebrand told Medscape. "It combines some kidney dialysis–type mechanisms with the liver dialysis. It uses a membrane to keep the charcoal solution separate from the patient's blood, which improves the compatibility of the machine."

64. Die Prognostische The prognostic significance of subclinical hepatic encephalopathy. http://hepatitis-c.de/abstract/405.htm

Signifikanz der subklinischen hepatischen Enzephalopathie Dieser Text wurde von einem Mitglied des Deutschen Hepatitis C Forum übersetzt. Für Nicht- Mediziner keine leichte Sache. Wir bitten deshalb zu berücksichtigen, daß wir für eine absolute Genauigkeit nicht garantieren können. English Original Am J Gastroenterol 2000 Aug;95(8):2029-34 Die prognostische Signifikanz der subklinischen hepatischen Enzephalopathie Hartmann IJ, Groeneweg M, Quero JC, Beijeman SJ, de Man RA, Hop WC, Schalm SW Department of Hepatogastroenterology, Erasmus University Hospital Rotterdam, The Netherlands. Ziel: Eine subklinische hepatische Enzephalopathie kann eine prognostische Signifikanz in Bezug auf die Entwicklung klinischer hepatischer Enzephalopathie und das Überleben haben. Methoden: Wir untersuchten 116 aufeinanderfolgende Patienten mit histologisch nachgewiesener Zirrhose der Leber auf subklinische hepatische Enzephalopathie, indem wir den Nummern- Verbindungstest A, den Ziffersymboltest und eine Spektralanalyse des Elektroenzephalogramms verwendeten. Ergebnisse: Fünfundzwanzig Patienten (22%) wurde mit subclinischer hepatischer Enzephalopathie diagnostiziert. Die Patienten mit subklinischer hepatischer Enzephalopathie waren älter, hatten einen höheren Child-Pugh Wert und hatten häufiger Oesophagus- oder Magenvarizen und eine (mehrere) Episode(n) klinischer hepatischer Enzephalopathie in ihrer Krankengeschichte. Während einer mittleren Nachbeobachtung von 29 Monaten (Bereich, 1-49 Monate) hatten Patienten mit subklinischer hepatischer Enzephalopathie signifikant häufiger Episoden von klinischer hepatischer Enzephalopathie; das Überleben war jedoch vergleichbar mit dem von Patienten ohne subklinische hepatische Enzephalopathie und wurde hauptsächlich bestimmt durch den Child- Pugh Wert. Der Child- Pugh- Wert war der subklinischen hepatischen Enzephalopathie auch überlegen bei der Vorhersage von Episoden der klinischen hepatischen Encephalopathie.

65. Stage Of Encephalopathy Motor Findings Subclinical Impaired Motor 17 17.07 Stages of hepatic encephalopathy. Overview 1996. Riordan SM WilliamsR. Treatment of hepatic encephalopathy. N Engl J Med. 1997; 337 473479. http://www.medal.org/docs_ch17/doc_ch17.07.html

Table of Contents, Chap. 17 Encephalopathy Overview: Patients with end stage liver disease can develop a metabolic encephalopathy. The severity of the encephalopathy can be graded by clinical signs and symptoms. Stage of Encephalopathy Motor Findings subclinical impaired motor performance detectable on standardized or bedside tests I fine tremor slowed coordination incoordination asterixis apraxia II asterixis dysarthria primitive reflexes (suck and snout) ataxic paratonia hypoactive reflexes III hyperreflexia extensor plantar response incontinence myoclonus hyperventilation IV decerebrate posturing brisk oculocephalic reflexes response to painful stimuli early may progress to flaccidity and absence of response to stimuli Stage of Encephalopathy Mental Findings subclinical no changes on routine examination may show impaired work performance may show impaired driving ability I mild confusion apathy agitation anxiety euphoria restlessness sleep disorder impaired handwriting forgetfulness irritability II drowsiness lethargy disoriented to time inappropriate behavior slow responses III somnolent but rousable marked confusion incomprehensible speech disoriented to place aggressive behavior IV coma (nonrousable) Clinical Findings asterixis: abnormal irregular distal involuntary jerking movement best shown with hands pronated and arms outstretched with fingers extended.

66. Hepatic Encephalopathy - General Practice Notebook medical information from General Practice Notebook. hepatic encephalopathy.hepatic encephalopathy is a metabolic disorder of the http://www.gpnotebook.co.uk/cache/1194655752.htm

hepatic encephalopathy Hepatic encephalopathy is a metabolic disorder of the central nervous system and neuromuscular system that may complicate liver failure from any cause. It is particularly associated with advanced cirrhosis on account of the diffuse parenchymal damage and portosystemic shunting. The features depend on the aetiology and precipitating factors, eventually developing into stupor and then coma. Some aetiologies of the hepatic failure, for example paracetamol overdose, can precipitate this condition within three or four days, with a very rapid progression through the grades of encephalopathy. Other aetiologies, for example viral hepatitis, are associated with a much more variable onset. The grade of the encephalopathy can be used to predict the prognosis - for example grades I and II have and excellent prognosis, grades III and IV have poorer prognoses with the development of complications. Click here for more information...

67. TOC-Unit 12 Radiographic Example; TIPS Indications; TIPS Results; TIPS Complicationof hepatic encephalopathy; TIPS Shunt Stenosis and Occlusion; TIPS http://www.milner-fenwick.com/agaslides/ctpunits/ctoc12.htm

Complications of Cirrhosis CTP 12 Table of Contents Introduction: Complications of Cirrhosis Portal Hypertensive Bleeding Normal Portal Venous Anatomy Measurement of Portal Pressure Classification of Portal Hypertension Risks of Varices and Variceal Bleeding Risk of Variceal Bleeding After Diagnosis of Cirrhosis Risk Factors for Bleeding From Esophageal Varices Variceal Bleeding According to Size of Varices Endoscopic Photo: Varices Without Stigmat Endoscopic Photo: Varices With Stigmata Hepatic Venous Pressure Gradient as a Predictor of Variceal Bleeding Bleeding Ectopic Varices Acute Variceal Bleeding: Initial Management Acute Variceal Bleeding: Somatostatin or Octreotide Acute Variceal Bleeding: Vasopressin and Nitroglycerin Acute Variceal Bleeding: Sclerotherapy Acute Variceal Bleeding: Endoscopic Ligation Acute Variceal Bleeding: Meta-analysis of Rebleeding Following Ligation Versus Sclerotherapy Acute Variceal Bleeding: Meta-analysis of Mortality Following Ligation Versus Sclerotherapy Recurrent Variceal Bleeding: Prevention Strategies Recurrent Variceal Bleeding: Prevention With Beta-blockers TIPS: Schematic of Procedure TIPS: Schematic of Shunt in Place TIPS: Radiographic Example TIPS: Indications TIPS: Results TIPS: Complication of Hepatic Encephalopathy TIPS: Shunt Stenosis and Occlusion TIPS: Gray-scale Ultrasound Showing Patent Stent TIPS: Color Doppler Ultrasound Showing Patent Stent TIPS: Color Doppler Ultrasound Showing Occluded Stent Child-Pugh Criteria Survival by Child's Class After Placement of TIPS

68. SLUCare . hepatic encephalopathyis the result of biochemical abnormalities associated with liver failure....... hepatic encephalopathy. Definition. (Back to Top). http://www.slucare.edu/patient/library/articles/331.shtml

Medical Terminology Library A B C D ... P Q R S T U ... W X Y Z Hepatic Encephalopathy Definition This is a condition that usually occurs secondary to advanced liver disease and is marked by a disturbance of mental functioning. Hepatic means "of the liver" and Encephalopathy means "a disorder of the brain." (Back to Top) Description Hepatic encephalopathy is the result of biochemical abnormalities associated with liver failure. Although disturbed ammonia metabolism is one component of hepatic encephalopathy, it is clear that ammonia is not solely responsible for the disturbed mental status. Encephalopathy is the mandatory clinical feature for diagnosis of acute liver failure. Difficulties in the recognition of the early stages of encephalopathy and distinction from drug-induced and renal (kidney)-induced alterations of mental state do not detract from the value of this sign as the most powerful clinical indicator of the severity of liver disease. Once encephalopathy develops, the patient is at high risk for the development of cerebral edema and multiorgan failure. (Back to Top) Causes and Risk Factors Hepatic encephalopathy may be aggravated by sepsis. Bleeding into the intestinal tract may significantly increase the amount of protein in the bowel and may precipitate rapid development of liver coma.

69. CAP In The News - CAP TODAY - Q&A measured, plasma ammonia concentrations have usually been found to correlate poorlywith the clinical stage of hepatic encephalopathy whether arterial or http://www.cap.org/captoday/archive/2002/qa_0902.html

September 2002 Q. We perform blood ammonia determinations using plasma from venous blood. One of our gastroenterologists insists that arterial blood is the preferred specimen for accurate ammonia levels. I have seen several references to the use of this type of specimen in the gastroenterology literature, but I have been unable to find any recommendation for the routine use of arterial blood in clinical laboratory textbooks. Can you help me resolve this? A. Plasma ammonia determinations have always been problematic for a number of reasons. The normal concentration is in the micromolar range, making the test susceptible to a variety of preanalytical errors. Even when carefully measured, plasma ammonia concentrations have usually been found to correlate poorly with the clinical stage of hepatic encephalopathy whether arterial or venous blood is used, and although ammonia is usually elevated, a normal level does not rule out early-stage hepatic encephalopathy. Ammonia is produced in the gastrointestinal tract by the action of bacterial enzymes on proteins and amino acids. It enters the portal circulation and is normally metabolized in the liver to urea and glutamine. When the liver is unable to perform this function, increased amounts of ammonia enter the arterial circulation and diffuse across the blood-brain barrier. Ammonia levels in peripheral venous blood are affected by additional variables. Muscle cells produce ammonia during exercise, but can take up ammonia when resting. It has been shown that the arteriovenous difference is near zero in normal individuals at rest, but that in hyperammonemic states, muscle serves as an important site for uptake of ammonia with subsequent conversion to glutamine. Arteriovenous differences in chronic hepatic insufficiency are typically 20-30 µmol/L.

70. Hepatic Encephalopathy hepatic encephalopathy. Alternate Names Hepatic coma; Encephalopathy hepatic. Hepaticencephalopathy is caused by disorders affecting the liver. http://www.rwjuhh.net/Atoz/encyclopedia/article/000302.asp

For a complete list of hospital classes and events, click here to connect to HealthConnection Online Medical Encyclopedia Encyclopedia Disease H -> Hepatic encephalopathy Hepatic encephalopathy Alternate Names: Hepatic coma; Encephalopathy - hepatic 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. In people with otherwise stable liver disorders, hepatic encephalopathy may be triggered by episodes of gastrointestinal bleeding, excessive dietary protein electrolyte abnormalities (especially decrease in potassium, which may result from

71. Centro Medico Teknon : Library . hepatic encephalopathy is theresult of biochemical abnormalities associated with liver failure....... Translate this page hepatic encephalopathy Definition http://www.teknon.es/Library/Library.asp?368

72. ¸ÎÐÔÄÔ²¡(Hepatic Encephalopathy) The summary for this Chinese (Simplified) page contains characters that cannot be correctly displayed in this language/character set. http://www.daoyi.com/disease/html/200009/5000000180750.html

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73. HEPATIC ENCEPHALOPATHY hepatic encephalopathy A condition which is used to describe the deleteriouseffects of liver failure on the central nervous system. http://www.mymedadvice.com/html/4/gls_2391.htm

HEPATIC ENCEPHALOPATHY - A condition which is used to describe the deleterious effects of liver failure on the central nervous system. Features include confusion ranging to unresponsiveness ( coma ). A common cause is alcoholic cirrhosis . Treatment includes the binding and elimination of ammonia in the intestinal tract . General life support including respiratory support and cardiovascular support may also be required. See encephalopathy for additional details.

74. Brain Histamine And Hepatic Encephalopathy Julkaisu. Reference. Lozeva V. Brain Histamine and hepatic encephalopathy.Central Histaminergic Mechanisms in Rats with Portacaval http://www.uku.fi/wwwdata/julkaisutoiminta/julkaisut/1999/9900253.html

Julkaisu Reference Lozeva V. Brain Histamine and Hepatic Encephalopathy. Central Histaminergic Mechanisms in Rats with Portacaval Anastomosis - Potential Effects on Physiology and Behaviour. Doctoral dissertation. 1999. Kuopio University Publications D. Medical Sciences 175. 86 p., append. Julkaisutiedot Julkaisutyyppi: Artikkeliväitöskirja. Kansallinen. Kieli: Englanti. Yliopiston omaa tuotantoa. Publication data Publication type: Doctoral dissertation (articles). National. In English. Published by the University. Tekijät Contributors Kuopion yliopisto Farmakologian ja toksikologian laitos Violina Lozeva University of Kuopio Department of Pharmacology and Toxicology Violina Lozeva Julkaisutietokanta Publications Data Base

75. Changes In Brain Histamine H1 Receptors In Chronic Hepatic Encephalopathy Lozeva V, Sola D, Plumed C, Attila M, Hippeläinen M, Butterworth R, Tuomisto L.Changes in brain histamine H1 receptors in chronic hepatic encephalopathy. http://www.uku.fi/wwwdata/julkaisutoiminta/julkaisut/2001/200101514.html

Julkaisu Reference Lozeva V, Sola D, Plumed C, Attila M, Hippeläinen M, Butterworth R, Tuomisto L. Changes in brain histamine H1 receptors in chronic hepatic encephalopathy. In: Watanabe T, Timmerman H, Yanai K, eds. Histamine Research in the New Millennium , p. 267-272. Amsterdam: Elsevier, 2001. International Congress Series 1224. Julkaisutiedot Julkaisutyyppi: Luku tiet. kirjassa/sarjaj:ssa. Kansainvälinen. Kieli: Englanti. Publication data Publication type: Chapter in monograph/series. International. In English. Tekijät Contributors Kuopion yliopisto Farmakologian ja toksikologian laitos Violina Lozeva Leena Tuomisto Kirurgian klinikka Mikko Hippeläinen University of Kuopio Department of Pharmacology and Toxicology Violina Lozeva Leena Tuomisto Department of Surgery Mikko Hippeläinen Kuopion yliopistollinen sairaala Kirurgian klinikka Mikko Hippeläinen Kuopio University Hospital Department of Surgery Mikko Hippeläinen Julkaisutietokanta Publications Data Base

76. DOE Human Subjects Research 1995 It has been reported that FMZ also reverses the coma seen in chronic hepatic encephalopathyand this observation has led to the suggestion that in hepatic http://www.eml.doe.gov/hsrd/hsr95/UMH.htm

USDOE Human Subjects Research Database, Fiscal Year 1995 University of Michigan Hospitals Public Information Contact: Dr. David E. Kuhl Division of Nuclear Medicine B1 G505 UH Ann Arbor, MI 48109-0028 Phone: Fax: Email: dkuhl@umich.edu Institutional Review Board (IRB): Projects are approved by an IRB located at: University of Michigan Hospitals. The approving IRB operates under a Multiple Project Assurance (MPA) recognized by DOE or by the Department of Health and Human Services (HHS). MPA number of the IRB: M-1184 Human Subjects Projects: Number of Human Subjects Projects reported: UMH-79-NS15655 Positron Emission Tomography (PET) Study of the Biochemistry and Metabolism of the Central Nervous System (CNS) UMH-86-NS24896 Emission Computed Tomography of Local Cerebral Function UMH-93-N149310462 Working Memory as Revealed by Positron Emission Tomography (PET) Go to Human Subjects Research 1995 main page Project Identification: Project Identifier: UMH-79-NS15655 Project Title: Positron Emission Tomography (PET) Study of the Biochemistry and Metabolism of the Central Nervous System (CNS) Principle Investigator: Dr. David E. Kuhl

77. Cátedra Santiago Grisolía 2002 Ciudad de las Artes y las Ciencias. INTERNATIONAL SYMPOSIUM ON HYPERAMMONEMIA,LIVER FAILURE AND hepatic encephalopathy. ABSTRACTS. http://www.cac.es/fundacion/symposium_abstracts.htm

78. Cátedra Santiago Grisolía 2002 Ciudad de las Artes y las Ciencias. INTERNATIONAL SYMPOSIUM ON HYPERAMMONEMIA,LIVER FAILURE AND hepatic encephalopathy. PROGRAM. Saturday, October 20th. http://www.cac.es/fundacion/program.htm

79. Liver Encephalopathy Also known as hepatic encephalopathy or hepatic coma, this condition can causeconfusion, disorientation, abnormal neurological signs, loss of consciousness http://www.healthatoz.com/healthatoz/Atoz/ency/liver_encephalopathy.html

Encyclopedia Index L Home Encyclopedia Encyclopedia Index L Liver encephalopathy Definition Liver encephalopathy is a potentially life-threatening disease in which toxic substances accumulate in the blood. Also known as hepatic encephalopathy or hepatic coma , this condition can cause confusion, disorientation, abnormal neurological signs, loss of consciousness, and death Description A normally functioning liver metabolizes and detoxifies substances formed in the body during the digestive process. Impaired liver function allows substances like ammonia (formed when the body digests protein), some fatty acids, phenol, and mercaptans to escape into the bloodstream. From there, they may penetrate the blood-brain barrier, affect the central nervous system (CNS), and lead to hepatic coma. Hepatic coma is most common in patients with chronic liver disease. It occurs in 50-70% of all those with cirrhosis Causes and symptoms The cause of hepatic coma is unknown, but the condition is frequently associated with the following conditions: Acute or chronic liver disease Gastrointestinal bleeding Azotemia, the accumulation of nitrogen-containing compounds (such as urea) in the blood

80. This Information Has Been Developed And Provided By An 1. Mullen KD, Dasarathy S hepatic encephalopathy. 3. Ferenci P, Puspok A, SteindlP Current concepts in the pathophysiology of hepatic encephalopathy. http://merck.praxis.md/bpm/bpmcited.asp?page=CPM02HP377

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