HEPATIC ENCEPHALOPATHY
Chronic
liver disease may cause broad spectrum of systemic manifestations that may
influence the clinical course. Hepatic encephalopathy (HE) incorporates a
spectrum of neuropsychiatric abnormalities seen in patients with liver
dysfunction without brain disease. The exact patophysiological mechanisms are
still not completely defined. Hepatic encephalopathy is predominantly seen in
patients with chronic liver disease and portal hypertension with shunting of
blood, bypassing the liver. The onset is often insidious characterized by subtle
and sometimes intermittent memory changes, changes of one’s personality,
concentration and reaction time. Manifestations of hepatic encephalopathy are
nonspecific, and it is important to exclude alternative diagnosis before
starting the therapy. The treatment of hepatic encephalopathy in patients with
acute and chronic liver failure is quite distinct. Beside clinically manifested
hepatic encephalopathy, there is also a subclinical stage defined as subtle or
subclinical neuropsychological deficit present in patients with liver disease
which cannot be detected by routine clinical examination. Acta Medica Medianae
2005; 44 (1): 73-79.
Key words: hepatic encephalopathy, liver cirrhosis,
ammonia