RESUMO
Hepatic encephalopathy (HE) is a major complication of liver disease that leads to significant morbidity and mortality. Caring for hospitalized patients with HE is becoming more complex, and the economic burden of HE continues to rise. Defining and diagnosing HE, particularly covert HE (CHE), remain challenging. In this article, we review new tools and those currently under development for the diagnosis of CHE and the latest advances in the acute and long-term management of overt HE (OHE) and CHE. In particular, we review the latest data on the use of lactulose and rifaximin for treatment of OHE and summarize the data on adjunctive agents such as sodium benzoate and probiotics.
Assuntos
Bartonella henselae/imunologia , Doença da Arranhadura de Gato , Doxiciclina/administração & dosagem , Exposição Ambiental , Fígado/patologia , Rifampina/administração & dosagem , Baço/diagnóstico por imagem , Animais , Antibacterianos/administração & dosagem , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/microbiologia , Doença da Arranhadura de Gato/fisiopatologia , Doença da Arranhadura de Gato/terapia , Gatos , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Testes Sorológicos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Patients with Barrett's esophagus (BE) and cirrhosis who develop high-grade dysplasia (HGD) or adenocarcinoma in the setting of esophageal varices present a unique therapeutic dilemma. There is limited literature regarding the optimal management of varices prior to invasive procedures or surgery involving the distal esophagus. We present a case of variceal decompression with a transjugular intrahepatic portosystemic shunt (TIPS) allowing for successful endoscopic mucosal resection (EMR) of BE with HGD overlying esophageal varices.