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Related Concept Videos

Hepatic Encephalopathy01:29

Hepatic Encephalopathy

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DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic...
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Portal Hypertension01:22

Portal Hypertension

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Portal hypertension is an increase in blood pressure within the portal venous system. Normally, this pressure is less than 5 mmHg. It is considered clinically significant when it rises above 10 mmHg. At this threshold, complications from altered blood flow and venous congestion emerge.EtiologyPortal hypertension arises from conditions that impede blood flow through the liver. The most common cause is cirrhosis, in which chronic liver injury leads to fibrotic scarring. This fibrosis narrows or...
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Hepatic Portal System01:21

Hepatic Portal System

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The hepatic portal system, a critical part of our circulatory framework, transports nutrient-laden, deoxygenated blood from the gastrointestinal tract and spleen to the liver. This ingenious system plays an indispensable role in maintaining our body's metabolic equilibrium.
At its core, the hepatic portal vein is the result of a confluence of the superior and inferior mesenteric veins along with the splenic vein. Each of these veins has a unique role. The superior mesenteric vein is...
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Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

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Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
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Encephalitis ll: Pathophysiology01:26

Encephalitis ll: Pathophysiology

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Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

271
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
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Portosystemic encephalopathy.

Karin Weissenborn1

  • 1Department of Neurology, Hanover Medical School, Hanover, Germany.

Handbook of Clinical Neurology
|December 25, 2013
PubMed
Summary
This summary is machine-generated.

Hepatic encephalopathy (HE) in cirrhosis patients can cause cognitive and motor issues. For chronic forms like acquired hepatocerebral degeneration, liver transplantation is crucial when standard ammonia reduction fails.

Keywords:
Hepatic encephalopathyclinical featuresdifferential diagnosisminimal hepatic encephalopathytherapy

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Area of Science:

  • Hepatology
  • Neurology
  • Gastroenterology

Background:

  • Portosystemic or type C hepatic encephalopathy (HE) is a common complication in liver cirrhosis, indicating a poor prognosis.
  • HE manifests as cognitive, consciousness, and motor function alterations, typically episodic but sometimes chronic.

Observation:

  • Chronic progressive HE, including acquired hepatocerebral degeneration and hepatic myelopathy, presents with predominant motor symptoms.
  • Pathophysiology involves hyperammonemia, exacerbated by inflammation, hyponatremia, or benzodiazepines.

Findings:

  • Standard HE therapies target ammonia reduction and precipitating factors (protein overload, infection, constipation, medication).
  • These standard treatments are ineffective for acquired hepatocerebral degeneration and hepatic myelopathy.

Implications:

  • Early consideration of liver transplantation is vital for patients with chronic progressive HE, specifically acquired hepatocerebral degeneration and hepatic myelopathy.
  • This highlights a critical treatment distinction for specific HE subtypes, emphasizing the need for timely intervention beyond ammonia management.