Hepatic encephalopathy pathophysiology

Butterworth RF, Lavoie J, Peterson C, Cotman CW, Szerb J Excitatory amino acids and hepatic encephalopathy in Pomier Larargue G, Butterworth RF (eds) Hepatic Encephalopathy Pathophysiology and Treatment. Clifton, Humana Press, 1989, pp 417-433. 

Infection, gastrointestinal bleeding or injudicious use of sedatives and diuretics can precipitate hepatic encephalopathy in cirrhotic patients. The pathophysiology is complex but ammonia appears to hold a central role. Derived mainly from the action of colonic urease-containing bacteria, ammonia is... 

Ferenci, P., Piispok, A., Steindi, P Current concepts in the pathophysiology of hepatic encephalopathy. Eur. X Clin. Invest. 1992 22 573-581... 

Hazell AS, Butterworth RF. Hepatic encephalopathy An update of pathophysiologic mechanisms. Proc Soc Exp Biol Med 1999 222 99-112. 

The pathophysiology of hepatic encephalopathy is not completely understood but includes an increased sensitivity to dietary proteins. Ammonia concentrations are always increased with acute encephalopathy and usually increased with chronic encephalopathy. A reduction of plasma ammonia is often associated with symptomatic improvement. However, since plasma ammonia concentrations do not correlate with the severity of the encephalopathy, it has been suggested that other factors are involved. It is now recognized that a variety of neurotransmitter systems are dysfunctional in hepatic encephalopathy, but the exact cause for the changes is not known. One important contributor is the endogenous benzodiazepine agonist system, but other abnormalities must be invoked to explain all the findings. ... 

Colquhoun S, Lipkin C, Connelly C. The pathophysiology, diagnosis, and management of acute hepatic encephalopathy Adv Intern Med 2001 46 155-76. 

Cirrhosis and the pathophysiologic abnormalities that cause it result in the commonly encountered problems of ascites, portal hypertension and esophageal varices, hepatic encephalopathy, and coagulation disorders. Other less commonly seen problems in patients with cirrhosis include hepatorenal syndrome, hepatopulmonary syndrome, and endocrine dysfunction, and these are discussed in the section dealing with management of complications. 

Pathophysiology of Hepatic Encephalopathy Studies in Animal Models... 

Adams RD, Foley JM. The neurological disorder associated with liver disease. In Metabolic and Toxic Diseases of the Nervous System. (H.H. Merritt, and C.C. Hare, eds.)Vol. 32. WiUiams and Wilkins, Baltimore, USA, pp. 198-237, 1953 Ahboucha S, Butterworth RF. The neurosteroid system Implication in the pathophysiology of hepatic encephalopathy. Neurochem. Int., 52, 575-587, 2008 Ahboucha S, Pomier-Layrargues G, Mamer O, Butterworth RF. Increased brain concentrations of a neuroinhibitory steroid in human hepatic encephalopathy. Arm. Neurol, 58, 169-170, 2005 Ahboucha S, Coyne L, Hirakawa R, Butterworth RF, Halliwell RF. An interaction between benzodiazepines and neuroactive steroids at GABA receptors in cultured hippocampal neurons. Neurochem. Int., 48, 703-707, 2006... 

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