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Portal Systemic Encephalopathy

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Outcome of non-surgical dietary treatment with or without lactulose in dogs with congenital portosystemic shunts.

Robert P Favier, Eline de Graaf, Ronald J Corbee, Anne Kummeling,

Background: Congenital portosystemic shunts (CPSS) are vascular anomalies, allowing portal blood to bypass the hepatic parenchyma, thereby accumulating toxic substances such as ammonia in the systemic circulation resulting in hepatic encephalopathy.Aim: To evaluate the outcome of non-surgically treated dogs with a CPSS.Methods: Case records of 78 dogs with a single ... Read more >>

Vet Q (The veterinary quarterly)
[2020, 40(1):108-114]

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High-dose ulinastatin to prevent late-onset acute renal failure after orthotopic liver transplantation.

Haijin Lv, Xuxia Wei, Xiaomeng Yi, Jianrong Liu, Pinglan Lu, Mi Zhou, Yuling An, Huimin Yi,

Purpose: To compare the efficacy and safety of two distinct doses of ulinastatin on late-onset acute renal failure (LARF) following orthotopic liver transplantation (OLT).Methods: The high-risk recipients that underwent OLT were divided into two groups according to ulinastatin dose: low-dose (LD) ulinastatin group, 0.8 million U/d; high-dose (HD) ulinastatin group, ... Read more >>

Ren Fail (Renal failure)
[2020, 42(1):137-145]

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Zinc and Probiotic Therapy for Management of Hepatic Encephalopathy.

Alessa D Gonzales, Justin P Reinert,

Hepatic encephalopathy is a complication of decompensated liver disease that consumes considerable health care resources and has a negative impact on quality of life. For several decades, maintenance therapy with lactulose has been considered the standard of care, but emerging data from clinical trials demonstrate that other therapeutic options may ... Read more >>

Sr Care Pharm (The Senior care pharmacist)
[2020, 35(4):171-175]

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EncephalApp Stroop App predicts poor sleep quality in patients with minimal hepatic encephalopathy due to hepatitis B-induced liver cirrhosis.

Ming Luo, Xiao-Bing Yu, Sheng-Juan Hu, Fei-Hu Bai,

Background/Aim:A novel computerised Stroop test- EncephalApp Stroop App (EncephalApp) has good diagnostic validity for minimal hepatic encephalopathy (MHE) in cirrhotic patients. The Stroop test is correlated with sleep disturbances which are common, and severely affects health-related quality of life in cirrhotic patients with MHE. We evaluated the relationship between sleep ... Read more >>

Saudi J Gastroenterol (Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association)
[2020, :]

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The combination of balloon-assisted antegrade transvenous obliteration and transjugular intrahepatic portosystemic shunt for the management of cardiofundal varices hemorrhage.

Jiacheng Liu, Chongtu Yang, Songjiang Huang, Chen Zhou, Qin Shi, Kun Qian, Songlin Song, Bin Xiong,

OBJECTIVES:In this study, we propose a modified balloon-occluded retrograde transvenous obliteration (BRTO) strategy - balloon-assisted antegrade transvenous obliteration (BAATO), and explore the feasibility, efficacy and safety of BAATO combined with transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cardiofundal varices (GOV2 or IGV1) hemorrhage. MATERIALS AND METHODS:In this retrospective ... Read more >>

Eur J Gastroenterol Hepatol (European journal of gastroenterology & hepatology)
[2020, 32(5):656-662]

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Nifuroxazide attenuates experimentally-induced hepatic encephalopathy and the associated hyperammonemia and cJNk/caspase-8/TRAIL activation in rats.

Ahmed E Khodir, Eman Said,

Hyperammonemia is a serious metabolic disorder associating with hepatic encephalopathy (HE) which occurs secondary to several forms of liver injury ranging from simple acute liver failure (ALF) to its most serious form; cirrhosis. The resent study highlights the possible ameliorative effect of oral nifuroxazide (25 mg/kg) against experimentally induced ALF and ... Read more >>

Life Sci. (Life sciences)
[2020, :117610]

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Important Unresolved Questions in the Management of Hepatic Encephalopathy: An ISHEN Consensus.

Jasmohan S Bajaj, Mette Lauridsen, Elliot B Tapper, Andres Duarte-Rojo, Robert S Rahimi, Puneeta Tandon, Debbie L Shawcross, Dominique Thabut, Radha K Dhiman, Manuel Romero-Gomez, Barjesh C Sharma, Sara Montagnese,

Management of hepatic encephalopathy (HE) remains challenging from a medical and psychosocial perspective. Members of the International Society for Hepatic Encephalopathy and Nitrogen Metabolism recognized 5 key unresolved questions in HE management focused on (i) driving, (ii) ammonia levels in clinical practice, (iii) testing strategies for covert or minimal HE, ... Read more >>

Am. J. Gastroenterol. (The American journal of gastroenterology)
[2020, :]

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Exploration of interventional therapy strategy for portal vein occlusion: a case series study.

Jiacheng Liu, Chen Zhou, Qin Shi, Jinqiang Ma, Tianhe Ye, Chuansheng Zheng, Gansheng Feng, Bin Xiong,

OBJECTIVES:To explore the candidates, efficacy and safety of interventional therapies in the treatment of portal vein occlusion (PVO). METHODS:In our study, 13 patients diagnosed with PVO were included. Of all 13 patients, two received percutaneous portal vein recanalization (PVR), 10 received PVR and transjugular intrahepatic portosystemic shunt (PVR-TIPS), and one ... Read more >>

Eur J Gastroenterol Hepatol (European journal of gastroenterology & hepatology)
[2020, 32(4):507-516]

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History of Hepatic Encephalopathy.

Vinod K Rustgi,

Clin Liver Dis (Clinics in liver disease)
[2020, 24(2):xiii-xvii]

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Reduced Cortical Complexity in Cirrhotic Patients with Minimal Hepatic Encephalopathy.

Qiu-Feng Chen, Xiao-Hong Zhang, Tian-Xiu Zou, Nao-Xin Huang, Hua-Jun Chen,

Purpose:Gray matter volume loss, regional cortical thinning, and local gyrification index alteration have been documented in minimal hepatic encephalopathy (MHE). Fractal dimension (FD), another morphological parameter, has been widely used to describe structural complexity alterations in neurological or psychiatric disease. Here, we conducted the first study to investigate FD alterations ... Read more >>

Neural Plast. (Neural plasticity)
[2020, 2020:7364649]

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Clinical management of type C hepatic encephalopathy.

Lorenzo Ridola, Oliviero Riggio, Stefania Gioia, Jessica Faccioli, Silvia Nardelli,

Type-C hepatic encephalopathy is a complex neurological syndrome, characteristic of patients with liver disease, causing a wide and complex spectrum of nonspecific neurological and psychiatric manifestations, ranging from a subclinical entity, minimal hepatic encephalopathy, to a deep form in which a complete alteration of consciousness can be observed: overt hepatic ... Read more >>

United European Gastroenterol J (United European gastroenterology journal)
[2020, :2050640620909675]

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Minimal Hepatic Encephalopathy.

Briette Verken Karanfilian, Taeyang Park, Frank Senatore,

Minimal hepatic encephalopathy, previously called subclinical hepatic encephalopathy, represents the earliest and mildest form of hepatic encephalopathy. It is the most under-recognized and underdiagnosed form of hepatic encephalopathy. Although there is no diagnostic gold standard, validated testing modalities have been devised to detect this neurocognitive complication. The newest developments include ... Read more >>

Clin Liver Dis (Clinics in liver disease)
[2020, 24(2):209-218]

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Non-cirrhotic Extra-Hepatic Porto-Systemic Shunt Causing Adult-Onset Encephalopathy Treated with Endovascular Closure.

Massimiliano Allegritti, Benedetta Enrico, Emanuela Basile, Lara de Vito, Antonino Morabito, Roberto Cirocchi, Michela Giustozzi, Giovanni Passalacqua,

INTRODUCTION:Encephalopathy secondary to hyperammonemia due to Congenital Extra-hepatic Porto-systemic shunt (CEPS) in the absence of liver cirrhosis is an exceptionally unusual condition. We describe the case of a 54-year-old woman admitted to the Emergency Department complaining of recurrent episodes of confusion and worsening cognitive impairment. At admission, the patient displayed ... Read more >>

Dig. Dis. Sci. (Digestive diseases and sciences)
[2020, 65(4):946-951]

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Novel Therapies in Hepatic Encephalopathy.

Maryam Alimirah, Omar Sadiq, Stuart C Gordon,

Despite widespread use of lactulose and rifaximin for the treatment of hepatic encephalopathy, this complication of advanced liver disease remains a major burden on the health care system in the United States and continues to predispose to high morbidity and mortality. Several agents have surfaced over recent years with promise ... Read more >>

Clin Liver Dis (Clinics in liver disease)
[2020, 24(2):303-315]

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The Health Care Burden of Hepatic Encephalopathy.

Mohamed I Elsaid, Tina John, You Li, Sri Ram Pentakota, Vinod K Rustgi,

Hepatic encephalopathy is a major neuropsychiatric complication of liver disease that affects 30% to 40% of cirrhotic patients. Hepatic encephalopathy is characterized by a brain dysfunction that is associated with neurologic complications. Those complications are associated with cognitive impairments, which negatively impacts patients' physical and mental health. In turn, hepatic ... Read more >>

Clin Liver Dis (Clinics in liver disease)
[2020, 24(2):263-275]

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Prognosis of Hepatic Encephalopathy.

Anita Krishnarao, Fredric D Gordon,

The presence of hepatic encephalopathy is often associated with worse clinical outcomes and increased mortality. Even subclinical hepatic encephalopathy has clinical impacts on daily life and has been linked to increased falls, motor vehicle accidents, and hospitalizations. The presence and degree of hepatic encephalopathy can also affect survival outcomes in ... Read more >>

Clin Liver Dis (Clinics in liver disease)
[2020, 24(2):219-229]

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Laboratory Abnormalities of Hepatic Encephalopathy.

Briette Verken Karanfilian, Maggie Cheung, Peter Dellatore, Taeyang Park, Vinod K Rustgi,

Currently, there is no gold standard serologic or imaging modality to detect hepatic encephalopathy (HE). It is a clinical diagnosis gathered from the history and physical. Imaging is nonspecific; however, PET and MRI have shown areas of utility, but are not widely available, cost-efficient, or necessary for diagnosis. Electroencephalogram has ... Read more >>

Clin Liver Dis (Clinics in liver disease)
[2020, 24(2):197-208]

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Minimal Hepatic Encephalopathy and Mild Cognitive Impairment Worsen Quality of Life in Elderly Patients with Cirrhosis.

Jasmohan S Bajaj, Andres Duarte-Rojo, Jesse J Xie, Chathur Acharya, James Wade, Carlos Robles, Leroy R Thacker, Christopher Flud, Andrew Fagan, Mauricio Garcia-Saenz-de-Sicilia, Melanie B White, Megan Kelly, Vy Nguyen, Edith A Gavis, Hugo E Vargas,

BACKGROUND & AIMS:Patients with cirrhosis are growing older. The overlap between minimal hepatic encephalopathy (MHE) and pre-dementia mild cognitive impairment (MCI) could affect quality of life (QOL). We investigated the performance of elderly patients with cirrhosis on tests for MHE and MCI and their effects on QOL. METHODS:We recruited outpatients ... Read more >>

Clin. Gastroenterol. Hepatol. (Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association)
[2020, :]

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Nursing Management of Hepatic Encephalopathy.

Diana Rodenbaugh, Christina T Vo, Rhoda Redulla, Kathleen McCauley,

This article provides a background of hepatic encephalopathy, its relation to liver disease as well as its prevalence in the United States. A literature review provides an overview of HE discussing the pathophysiology, evidence-based diagnosis, and grading of the disease severity as well as treatment options and interventions. A large ... Read more >>

Gastroenterol Nurs (Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates)
[2020, 43(2):E35-E47]

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Non-cirrhotic hyperammonaemia: are we missing the diagnosis?

Yi Lin Lee, Siying Pang, Caroline Ong,

Hepatic encephalopathy secondary to hyperammonaemia is a known complication of chronic liver disease. In contrast, non-cirrhotic hyperammonaemia is a lesser-known entity that should be considered in a patient with acute encephalopathy as part of the diagnostic workup as prompt identification can help to avoid complications such as seizures and cerebral ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(3):]

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Astrocyte swelling in hepatic encephalopathy: molecular perspective of cytotoxic edema.

Ali Sepehrinezhad, Asadollah Zarifkar, Gholamreza Namvar, Ali Shahbazi, Roger Williams,

Hepatic encephalopathy (HE) may occur in patients with liver failure. The most critical pathophysiologic mechanism of HE is cerebral edema following systemic hyperammonemia. The dysfunctional liver cannot eliminate circulatory ammonia, so its plasma and brain levels rise sharply. Astrocytes, the only cells that are responsible for ammonia detoxification in the ... Read more >>

Metab Brain Dis (Metabolic brain disease)
[2020, :]

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Long-Term Management: Modern Measures to Prevent Readmission in Patients with Hepatic Encephalopathy.

Russell Rosenblatt, Johnathan Yeh, Paul J Gaglio,

Hepatic encephalopathy (HE) is a frequent indication for hospitalization and represents a common manifestation of portal hypertension and decompensated liver disease that contributes to hospital readmissions. Multiple new techniques are being evaluated to assist in preventing readmissions in these high-risk patients. Techniques to improve medication adherence are paramount. The use ... Read more >>

Clin Liver Dis (Clinics in liver disease)
[2020, 24(2):277-290]

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Aberrant brain structural network and altered topological organization in minimal hepatic encephalopathy.

Lu-Bin Gou, Wei Zhang, Da-Jing Guo, Wei-Jia Zhong, Xiao-Jia Wu, Zhi-Ming Zhou,

PURPOSE:We aimed to investigate the multilevel impairments of brain structural network in patients with minimal hepatic encephalopathy (MHE). METHODS:Twenty-two patients with MHE and 22 well-matched healthy controls (HC) underwent structural magnetic resonance imaging (MRI) brain scans and neuropsychological evaluations. Individual brain structural networks were constructed using diffusion tensor imaging. Comparing ... Read more >>

Diagn Interv Radiol (Diagnostic and interventional radiology (Ankara, Turkey))
[2020, :]

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Helicobacter pylori as an Initiating Factor of Complications in Patients With Cirrhosis: A Single-Center Observational Study.

Ahmed Abdel-Razik, Nasser Mousa, Rania Elhelaly, Rasha Elzehery, Ahmad S Hasan, Mostafa Abdelsalam, Ahmed Salah Seif, Ahmed M Tawfik, Niveen El-Wakeel, Waleed Eldars,

Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis. Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up ... Read more >>

Front Med (Lausanne) (Frontiers in Medicine)
[2020, 7:96]

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Epidemiology of Hepatic Encephalopathy.

Mohamed I Elsaid, Vinod K Rustgi,

Hepatic encephalopathy (HE) is a complex condition with multiple causes each with varying degrees of severity. HE negatively impacts patients' quality of life, and it is associated with significant burdens to patients and their caregivers. The prevalence of cirrhosis, the most common risk factor for HE, has steadily increased during ... Read more >>

Clin Liver Dis (Clinics in liver disease)
[2020, 24(2):157-174]

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