A report on Hepatic encephalopathy

Micrograph of Alzheimer type II astrocytes, as may be seen in hepatic encephalopathy
Ball and stick model of ammonia; one nitrogen atom with three hydrogen atoms. Accumulation of ammonia in the bloodstream is associated with hepatic encephalopathy.
Micrograph of Alzheimer type II astrocytes, as may be seen in hepatic encephalopathy
Micrograph showing liver cirrhosis, a condition that often precedes hepatic encephalopathy. Trichrome stain.

Altered level of consciousness as a result of liver failure.

- Hepatic encephalopathy
Micrograph of Alzheimer type II astrocytes, as may be seen in hepatic encephalopathy

23 related topics with Alpha

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Cross-section of human liver with cirrhosis

Cirrhosis

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Impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease.

Impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease.

Cross-section of human liver with cirrhosis
Person with cirrhosis and associated pain in the right upper region of the abdomen
Hepatitis C viral particles and the liver
Caudate lobe hypertrophy on ultrasound due to cirrhosis
Hepatofugal (non-forward) flow in portal vein
Liver cirrhosis on CT imaging of the abdomen in transverse view
Micrograph showing cirrhosis, trichrome stain
Cirrhosis deaths per million persons in 2012
No fibrosis, but mild zone 3 steatosis, in which collagen fibres (pink–red, arrow) are confined to portal tracts (P) (Van Gieson's stain)<ref name="BoydCain2020">{{cite journal | vauthors = Boyd A, Cain O, Chauhan A, Webb GJ |title=Medical liver biopsy: background, indications, procedure and histopathology |journal=Frontline Gastroenterology |volume=11 |issue=1 |year=2020 |pages=40–47 |issn=2041-4137 |doi=10.1136/flgastro-2018-101139 |pmid=31885839 |pmc=6914302}} -"This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license"</ref>
Histopathology of steatohepatitis with mild fibrosis in the form of fibrous expansion (Van Gieson's stain)
Histopathology of steatohepatitis with moderate fibrosis, with thin fibrous bridges (Van Gieson's stain)
Histopathology of steatohepatitis with established cirrhosis, with thick bands of fibrosis (Van Gieson's stain)
Trichrome stain, showing cirrhosis as a nodular texture surrounded by fibrosis (wherein collagen is stained blue).
Micronodular cirrhosis, with diffuse areas of pallor.
Pale macronodules of cirrhosis.
Cirrhosis leading to hepatocellular carcinoma
Disability-adjusted life year for cirrhosis of the liver per 100,000 inhabitants in 2004. no data <50 50-100 100-200 200-300 300-400 400-500 500-600 600-700 700-800 800-900 900–1000 >1000

More serious complications include hepatic encephalopathy, bleeding from dilated veins in the esophagus, stomach, or intestines, and liver cancer.

The development of ascites (as shown on this abdominal ultrasound) in cirrhotics that is refractory to the use of diuretic medications is associated with type 2 HRS.

Hepatorenal syndrome

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Life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure.

Life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure.

The development of ascites (as shown on this abdominal ultrasound) in cirrhotics that is refractory to the use of diuretic medications is associated with type 2 HRS.
Schematic demonstrating the underfill theory to explain the pathophysiology of both ascites and hepatorenal syndrome.
Diagram showing hypothesized correlation between clinical features and pathophysiology of ascites and hepatorenal syndrome.
Picture of the esophagus at the time of endoscopy showing prominent esophageal varices. Bleeding from esophageal varices can be a precipitant for hepatorenal syndrome in individuals with cirrhosis, and can be prevented by early diagnosis and treatment.
TIPS, shown in progress here, has been shown to improve kidney function in individuals with HRS if portal pressures decrease after the procedure.

Most people who develop HRS have cirrhosis, and may have signs and symptoms of the same, which can include jaundice, altered mental status, evidence of decreased nutrition, and the presence of ascites.

Acute liver failure (with hepatocellular necrosis and sinusoidal bleeding) from Marburg virus, a rare cause

Acute liver failure

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Appearance of severe complications rapidly after the first signs of liver disease, and indicates that the liver has sustained severe damage (loss of function of 80–90% of liver cells).

Appearance of severe complications rapidly after the first signs of liver disease, and indicates that the liver has sustained severe damage (loss of function of 80–90% of liver cells).

Acute liver failure (with hepatocellular necrosis and sinusoidal bleeding) from Marburg virus, a rare cause
Diagram of hepatobiliary system

The complications are hepatic encephalopathy and impaired protein synthesis (as measured by the levels of serum albumin and the prothrombin time in the blood).

Rifaximin

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Broad spectrum antibiotics mainly used to treat travelers' diarrhea.

Broad spectrum antibiotics mainly used to treat travelers' diarrhea.

Since its approval in Italy in 1987, it has been licensed in over more than 30 countries for the treatment of a variety of gastrointestinal diseases like irritable bowel syndrome, and hepatic encephalopathy.

A person with massive ascites and caput medusae due to cirrhotic liver failure

Liver failure

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Inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology.

Inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology.

A person with massive ascites and caput medusae due to cirrhotic liver failure

Acute liver failure is defined as "the rapid development of hepatocellular dysfunction, specifically coagulopathy and mental status changes (encephalopathy) in a patient without known prior liver disease".

The human liver is located in the upper right abdomen

Liver

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Major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth.

Major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth.

The human liver is located in the upper right abdomen
The liver, viewed from above, showing the left and right lobes separated by the falciform ligament
The liver, viewed from below, surface showing four lobes and the impressions
Impressions of the liver
Cells, ducts, and blood vessels
Hilum of the liver, circled in yellow
Shape of human liver in animation, with eight Couinaud segments labelled
CT scan showing an adult liver in the axial plane.
Adult ultrasound showing the right lobe of the liver and right kidney.
Biliary tract
Left lobe liver tumor
After resection of left lobe liver tumor
Maksalaatikko, a Finnish liver casserole
19th century drinking scene in Kordofan, home to the Humr tribe, who made a drink from giraffe liver. Plate from Le Désert et le Soudan by Stanislas d'Escayrac de Lauture.
Sheep's liver
Microscopic anatomy of the liver
Types of capillaries–sinusoid on right
alt=3D Medical Animation Still Shot Depicting parts of liver|3D Medical Animation Still Shot Depicting parts of liver
thumb|left|Liver veins
thumb|right|Diagram of liver, lobule, and portal tract and their inter-relations
Axial CT image showing anomalous hepatic veins coursing on the subcapsular anterior surface of the liver.<ref name="Sheporaitis">{{cite journal|pmid=9843288|year=1998|last1=Sheporaitis|first1=L|last2=Freeny|first2=PC|title=Hepatic and portal surface veins: A new anatomic variant revealed during abdominal CT|volume=171|issue=6|pages=1559–1564|doi=10.2214/ajr.171.6.9843288|journal=AJR. American Journal of Roentgenology}}</ref>
Maximum intensity projection (MIP) CT image as viewed anteriorly showing the anomalous hepatic veins coursing on the anterior surface of the liver
Lateral MIP view in the same patient
A CT scan in which the liver and portal vein are shown.
MDCT image. Arterial anatomy contraindicated for liver donation
MDCT image. Portal venous anatomy contraindicated for liver donation
MDCT image. 3D image created by MDCT can clearly visualize the liver, measure the liver volume, and plan the dissection plane to facilitate the liver transplantation procedure.
Phase contrast CT image. Contrast is perfusing the right liver but not the left due to a left portal vein thrombus.

Hepatic encephalopathy is caused by an accumulation of toxins in the bloodstream that are normally removed by the liver.

Lactulose

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Lactulose is a non-absorbable sugar used in the treatment of constipation and hepatic encephalopathy.

A brown ring on the edge of the iris (Kayser–Fleischer ring) is common in Wilson's disease, especially when neurological symptoms are present.

Wilson's disease

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Genetic disorder in which excess copper builds up in the body.

Genetic disorder in which excess copper builds up in the body.

A brown ring on the edge of the iris (Kayser–Fleischer ring) is common in Wilson's disease, especially when neurological symptoms are present.
Wilson's disease has an autosomal recessive pattern of inheritance.
Location of the basal ganglia, the part of the brain affected by Wilson's disease
Ceruloplasmin
Sunflower cataract and thick KF ring of a 40-year-old male with Wilson's disease and decompensated CLD
Diffuse illumination of cornea
Copper deposition on corneal Descemet's membrane

Liver disease may present itself as tiredness, increased bleeding tendency or confusion (due to hepatic encephalopathy) and portal hypertension.

Asterixis

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Tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings.

Tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings.

It can be a sign of hepatic encephalopathy, damage to brain cells presumably due to the inability of the liver to metabolize ammonia to urea. The cause is thought to be predominantly related to abnormal ammonia metabolism.

Ball-and-stick model of the diamminesilver(I) cation, [Ag(NH3)2]+

Ammonia

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Compound of nitrogen and hydrogen with the formula NH3.

Compound of nitrogen and hydrogen with the formula NH3.

Ball-and-stick model of the diamminesilver(I) cation, [Ag(NH3)2]+
Ball-and-stick model of the tetraamminediaquacopper(II) cation, [Cu(NH3)4(H2O)2](2+)
Jabir ibn Hayyan
This high-pressure reactor was built in 1921 by BASF in Ludwigshafen and was re-erected on the premises of the University of Karlsruhe in Germany.
A train carrying Anhydrous Ammonia.
Liquid ammonia bottle
Household ammonia
Ammoniacal Gas Engine Streetcar in New Orleans drawn by Alfred Waud in 1871.
The X-15 aircraft used ammonia as one component fuel of its rocket engine
Anti-meth sign on tank of anhydrous ammonia, Otley, Iowa. Anhydrous ammonia is a common farm fertilizer that is also a critical ingredient in making methamphetamine. In 2005, Iowa used grant money to give out thousands of locks to prevent criminals from getting into the tanks.
The world's longest ammonia pipeline (roughly 2400 km long), running from the TogliattiAzot plant in Russia to Odessa in Ukraine
Hydrochloric acid sample releasing HCl fumes, which are reacting with ammonia fumes to produce a white smoke of ammonium chloride.
Production trend of ammonia between 1947 and 2007
Main symptoms of hyperammonemia (ammonia reaching toxic concentrations).
Ammonia occurs in the atmospheres of the outer giant planets such as Jupiter (0.026% ammonia), Saturn (0.012% ammonia), and in the atmospheres and ices of Uranus and Neptune.

Hyperammonemia contributes to the confusion and coma of hepatic encephalopathy, as well as the neurologic disease common in people with urea cycle defects and organic acidurias.