New Advances in Hepatic Encephalopathy, An Issue of Clinics in Liver Disease

Jr Robert S. Brown

Description

Dr. Brown provides a timely upate on the clinical diagnosis and management of Hepatic Encephalopathy. His issue addresses current hot topics including Role of NH4 in Pathogenesis of Hepatic Encephalopathy; How to diagnose and manage HE in fulminant hepatic failure; New methods of Brain Imaging and testing (eg PET) and Hepatic Encephalopathy; Management New agents for HE (focus on NH4 lowering drugs used in UCD); Legal responsibility of MD when he diagnoses HE; Diets in Encephalopathy; and Neurological manifestations of HE.

Sujets

• Médecine
• Médecine Générale
• Medical
• Gastroenterology

Informations

• Publié par: Elsevier
• Date de parution: 19 octobre 2015
• Nombre de lectures: 0
• EAN13: 9780323376044
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Clinics Review Articles CLINICS IN LIVER DISEASE
New Advances in Hepatic Encephalopathy

Robert S. Brown, Jr., MD, MPH
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
ISSN  1089-3261 Volume 19 • Number 3 • August 2015
Elsevier
Table of Contents
Cover image
Title page
Copyright
Contributors
Consulting Editor
Editor
Authors
Forthcoming Issues
Forthcoming Issues
Recent Issues
Preface: HE or not HE? That is Frequently the Question
New Methods of Testing and Brain Imaging in Hepatic Encephalopathy
Key points
Introduction
Diagnosing hepatic encephalopathy
Psychometric tests
Stroop application
Ammonia
Brain imaging
Lumbar puncture
Electroencephalogram
Magnetic resonance spectroscopy
Single-photon emission computed tomography
PET
Summary
Clinical and Neurologic Manifestation of Minimal Hepatic Encephalopathy and Overt Hepatic Encephalopathy
Key points
Introduction
Mechanism: motor manifestations of minimal hepatic encephalopathy
Mechanism: cognitive impairment in minimal hepatic encephalopathy
Differential diagnosis of hepatic encephalopathy
Sleep disturbance
Capacity to drive
Summary
Covert Hepatic Encephalopathy
Key points
Background
Diagnosis
Clinical manifestations
Treatment
Should we test for covert hepatic encephalopathy and, if so, in whom?
Treatment strategies
Summary
Should We Treat Minimal/Covert Hepatic Encephalopathy, and with What?
Key points
Introduction
Covert encephalopathy: is it important?
Treatment
Summary
Diets in Encephalopathy
Key points
Introduction
General
Carbohydrate intake
Protein intake: normal or restricted?
Aromatic and branched-chain amino acids: vegetable versus animal protein
Fat, vitamins, supplements, probiotics, fiber
Summary
The Role of Sarcopenia and Frailty in Hepatic Encephalopathy Management
Key points
Introduction
Defining and measuring frailty and sarcopenia
Pathophysiology of frailty and sarcopenia in cirrhosis
Interorgan ammonia metabolism: physiologic association between muscle depletion and hepatic encephalopathy
The impact of sarcopenia and frailty on the risk of hepatic encephalopathy
The impact of frailty and sarcopenia on mortality in cirrhosis
Frailty and sarcopenia in liver transplant recipients
Management of frailty and sarcopenia in patients with cirrhosis and hepatic encephalopathy
Summary
Ammonia and Its Role in the Pathogenesis of Hepatic Encephalopathy
Key points
Introduction
Ammonia, the urea cycle, and the pathogenesis of hepatic encephalopathy
Ammonia and astrocyte swelling
Ammonia and glutamine
Ammonia and gamma-amino-n-butyric acid
Classification and clinical subtypes
Summary
Novel Ammonia-Lowering Agents for Hepatic Encephalopathy
Key points
Introduction
Ammonia scavengers
Polyethylene glycol
Summary
Treatment of Overt Hepatic Encephalopathy
Key points
Introduction
Clinical features
Management of hepatic encephalopathy
Initial assessment and management
Medical therapy for overt hepatic encephalopathy
Embolization of portosystemic shunts
Artificial liver support
Liver transplantation
Summary
Diagnosis and Management of Hepatic Encephalopathy in Fulminant Hepatic Failure
Key points
Introduction
Definition
Symptom criteria
Clinical findings
Diagnostic modalities
Pathology
Diagnostic dilemmas
Management
Potential future therapies
Summary
Legal Responsibilities of Physicians When They Diagnose Hepatic Encephalopathy
Key points
Introduction
Evidence that covert hepatic encephalopathy impairs skills necessary for safe driving or operating machinery
Clinical testing for covert hepatic encephalopathy
Can treatment of covert hepatic encephalopathy prevent motor vehicle accidents?
Legal ramifications for physicians who diagnose and treat patients with hepatic encephalopathy
Current practices regarding hepatic encephalopathy and driving
Recommendations
Summary
Copyright
Elsevier
1600 John F. Kennedy Boulevard • Suite 1800 • Philadelphia, Pennsylvania, 19103-2899
http://www.theclinics.com
CLINICS IN LIVER DISEASE Volume 19, Number 3
August 2015 ISSN 1089-3261, ISBN-13: 978-0-323-37603-7
Editor: Kerry Holland
Developmental Editor: Meredith Clinton
© 2015 Elsevier Inc. All rights reserved.
This periodical and the individual contributions contained in it are protected under copyright by Elsevier, and the following terms and conditions apply to their use:
Photocopying
Single photocopies of single articles may be made for personal use as allowed by national copyright laws. Permission of the Publisher and payment of a fee is required for all other photocopying, including multiple or systematic copying, copying for advertising or promotional purposes, resale, and all forms of document delivery. Special rates are available for educational institutions that wish to make photocopies for non-profit educational classroom use. For information on how to seek permission visit www.elsevier.com/permissions or call: ([phone] (UK)/([phone] (USA).
Derivative Works
Subscribers may reproduce tables of contents or prepare lists of articles including abstracts for internal circulation within their institutions. Permission of the Publisher is required for resale or distribution outside the institution. Permission of the Publisher is required for all other derivative works, including compilations and translations (please consult www.elsevier.com/permissions ).
Electronic Storage or Usage
Permission of the Publisher is required to store or use electronically any material contained in this periodical, including any article or part of an article (please consult www.elsevier.com/permissions ). Except as outlined above, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the Publisher.
Notice
No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.
Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer.
Clinics in Liver Disease (ISSN 1089-3261) is published quarterly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Months of issue are February, May, August, and November. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Ste. 1800, Philadelphia, PA 19103-2899. Customer Service Office: 3251 Riverport Lane, Maryland Heights, MO 63043. Periodicals postage paid at New York, NY and additional mailing offices. Subscription prices are $295.00 per year (U.S. individuals), $145.00 per year (U.S. student/resident), $401.00 per year (U.S. institutions), $395.00 per year (international individuals), $200.00 per year (international student/resident), $498.00 per year (international instituitions), $340.00 per year (Canadian individuals), $200.00 per year (Canadian student/resident), and $498.00 per year (Canadian institutions). Foreign air speed delivery is included in all Clinics subscription prices. All prices are subject to change without notice. POSTMASTER: Send address changes to Clinics in Liver Disease , Elsevier Health Sciences Division, Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043. Customer Service: Telephone: [phone] (U.S. and Canada); 314-447-8871 (outside U.S. and Canada). Fax: [phone]. E-mail: [e-mail] (for print support); [e-mail] (for online support).
Reprints . For copies of 100 or more of articles in this publication, please contact the Commercial Reprints Department, Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Tel.: [phone]; Fax: [phone]; E-mail: [e-mail] .
Clinics in Liver Disease is covered in MEDLINE/PubMed (Index Medicus) , Science Citation Index Expanded, Journal Citation Reports/Science Edition, and Current Contents/Clinical Medicine.
Printed in the United States of America.
Contributors

Consulting Editor
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG
Formerly, Professor of Medicine, Chief of Hepatology, Emory University; Currently, Consultant, Atlanta Gastroenterology Associates, Atlanta, Georgia

Editor
ROBERT S. BROWN Jr, MD, MPH
Vice Chair, Transitions of Care; Interim Chief, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York

Authors
GEORGE G. ABDELSAYED, MD, FACP, FACG
Director, Division of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, New York
LUIS A. BALART, MD, MACG
Chief, Division of Gastroenterology and Hepatology; Professor of Medicine, Department of Internal Medicine, Tulane University, New Orleans, Louisiana
P. PATRICK BASU, MD, MRCP, AGAF, FACG
Assistant Clinical Professor of Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Director of Liver and Clinical Liver Research, Department of Medicine, King’s County Hospital Medical Center, Brooklyn, New York
RAJA G.R. EDULA, MD, MRCP (UK)
Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
STEVEN L. FLAMM, MD
Professor of Medicine; Chief, Liver Transplantation Program