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1.
Curr Med Sci ; 39(5): 719-726, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612388

RESUMO

Hepatitis E virus (HEV) infection is a major cause of morbidity in endemic areas. Its consequences among chronic hepatitis B (CHB) patients have been under-reported. The aim of this study was to assess the impact of superinfective HEV infection (acute and past) on virological and clinical features of patients with CHB infection. Clinical, biochemical, virological and immunological data of 153 CHB patients including 98 with hepatitis B virus (HBV) monoinfection and 55 with HBV-HEV superinfection with both HEV and HBV infection was retrospectively investigated and analyzed in this study conducted in Wuhan, China. An overall anti-HEV IgG seroprevalence was found to be 35.9% in CHB patients. HBV-HEV superinfection patients showed significantly higher rate of complications (ascites, hepato-renal syndrome & encephalopathy) (all with P=0.04), cirrhosis (P<0.001) and acute-on-chronic liver failure (P<0.001) than HBV monoinfection patients. They also displayed elevated ALTs (P<0.001) and total serum bilirubin (P<0.001) with diminished albumin (P<0.001) and HBV viral load (P<0.001). Cytokines assay revealed increased expression of IL-6 (P=0.02), IL-10 (P=0.009) and TNF-α (P=0.003) in HBV-HEV superinfection patients compared to HBV monoinfection patients. Our study demonstrated that HEV superinfection in CHB patients was associated with progressive clinical manifestation, which is likely due to the enhanced expression of cytokines related with hepatocytes necrosis. HEV was also associated with repressed HBV replication, but the underlying mechanism requires further investigation.


Assuntos
Insuficiência Hepática Crônica Agudizada/virologia , Ascite/virologia , Encefalopatia Hepática/virologia , Hepatite B Crônica/virologia , Hepatite E/virologia , Síndrome Hepatorrenal/virologia , Cirrose Hepática/virologia , Superinfecção/virologia , Insuficiência Hepática Crônica Agudizada/complicações , Insuficiência Hepática Crônica Agudizada/imunologia , Insuficiência Hepática Crônica Agudizada/patologia , Adulto , Idoso , Alanina Transaminase/sangue , Alanina Transaminase/imunologia , Ascite/complicações , Ascite/imunologia , Ascite/patologia , Bilirrubina/sangue , Bilirrubina/imunologia , China , Feminino , Encefalopatia Hepática/complicações , Encefalopatia Hepática/imunologia , Encefalopatia Hepática/patologia , Anticorpos Anti-Hepatite/sangue , Vírus da Hepatite B/imunologia , Vírus da Hepatite B/patogenicidade , Hepatite B Crônica/complicações , Hepatite B Crônica/imunologia , Hepatite B Crônica/patologia , Hepatite E/complicações , Hepatite E/imunologia , Hepatite E/patologia , Vírus da Hepatite E/imunologia , Vírus da Hepatite E/patogenicidade , Hepatócitos/imunologia , Hepatócitos/patologia , Hepatócitos/virologia , Síndrome Hepatorrenal/complicações , Síndrome Hepatorrenal/imunologia , Síndrome Hepatorrenal/patologia , Humanos , Imunoglobulina G/sangue , Interleucina-10/sangue , Interleucina-10/imunologia , Interleucina-6/sangue , Interleucina-6/imunologia , Fígado/imunologia , Fígado/patologia , Fígado/virologia , Cirrose Hepática/complicações , Cirrose Hepática/imunologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Superinfecção/complicações
2.
Zhonghua Gan Zang Bing Za Zhi ; 27(9): 673-676, 2019 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594090

RESUMO

Objective: To investigate the incidence of hepatic encephalopathy (HE) in patients with non-cirrhotic portal hypertension (NCPH) and to explore its risk factors. Methods: The incidence rate of HE in 150 cases with NCPH was evaluated in two hospitals, and 188 cases of compensated cirrhosis patients were taken as control. Logistic regression was used to screen for independent risk factors for HE in patients with NCPH. Results: The incidence of overt hepatic encephalopathy (OHE) in patients with NCPH was not statistically significantly different from that in patients with cirrhosis (4.7% vs. 6.9%, P = 0.682). The incidence of mild hepatic encephalopathy (MHE) was significantly lower than that of cirrhosis patients (32.7% vs. 46.3%, P < 0.05). The presence of upper gastrointestinal bleeding, infection and portosystemic venous shunt were the main independent factors for HE in NCPH patients (OR > 1, P < 0.05). Conclusion: HE is one of the important complications of NCP, and may be influenced by factors such as upper gastrointestinal bleeding, infection and portosystemic venous shunt.


Assuntos
Encefalopatia Hepática/complicações , Hipertensão Portal/complicações , Hemorragia Gastrointestinal/complicações , Humanos , Cirrose Hepática , Derivação Portossistêmica Cirúrgica , Fatores de Risco
3.
N Engl J Med ; 381(21): 2043-2050, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31665575

RESUMO

Fecal microbiota transplantation (FMT) is an emerging therapy for recurrent or refractory Clostridioides difficile infection and is being actively investigated for other conditions. We describe two patients in whom extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli bacteremia occurred after they had undergone FMT in two independent clinical trials; both cases were linked to the same stool donor by means of genomic sequencing. One of the patients died. Enhanced donor screening to limit the transmission of microorganisms that could lead to adverse infectious events and continued vigilance to define the benefits and risks of FMT across different patient populations are warranted.


Assuntos
Bacteriemia/etiologia , Disbiose/terapia , Escherichia coli/isolamento & purificação , Transplante de Microbiota Fecal/efeitos adversos , Fezes/microbiologia , Idoso , Bacteriemia/microbiologia , Farmacorresistência Bacteriana , Disbiose/etiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/metabolismo , Evolução Fatal , Encefalopatia Hepática/complicações , Encefalopatia Hepática/terapia , Humanos , Masculino , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/terapia , beta-Lactamases/metabolismo
4.
Clin Drug Investig ; 39(9): 847-856, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31183628

RESUMO

BACKGROUND AND OBJECTIVES: Use of proton pump inhibitor (PPI) in patients with cirrhosis has been linked to the development of hepatic encephalopathy (HE). Little is known about the incidence rate of HE due to PPI therapy. We conducted a meta-analysis to explore the association between PPI use and the incidence of HE. METHODS: We searched PubMed, EMBASE databases and The Cochrane Library from inception to March 2019 for studies describing the association between PPI exposure and incidence of HE; we identified studies that provided the adjusted estimates of odds ratio (OR)/relative ratio (RR)/hazard ratio (HR), and the pooled RRs on the incidence of HE were calculated. Summary estimates were calculated using random effects models. RESULTS: We analyzed data from 10 eligible studies; PPI users had an increased risk of HE compared with non-PPI user, with a pooled RR of 1.81 (95% CI 1.58-2.06), with notable heterogeneity (I2 = 85.2%, p <0.0001). In subgroup of considering the incidence of HE after yrans-jugular intrahepatic portosystemic shunt (TIPS), the pooled RR was 3.09 (95% CI 2.23-4.27), with no statistical heterogeneity (I2 = 0.0%, p = 0.484); another subgroup analysis was conducted for the complication of the enrolled patients with the status of ascites, the pooled RR was 1.39 (95% CI 1.10-1.77). The result of statistical heterogeneity was low (I2 = 46.2%, p = 0.156). CONCLUSIONS: We found PPI therapy increased the risk of HE in cirrhotic patients, and higher risk was found in post-operative TIPS. Additional studies are warranted to inform clinical decision making.


Assuntos
Encefalopatia Hepática/induzido quimicamente , Cirrose Hepática/complicações , Inibidores da Bomba de Prótons/efeitos adversos , Ascite , Encefalopatia Hepática/complicações , Humanos , Incidência , Razão de Chances
5.
Rev Med Liege ; 74(5-6): 310-313, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31206272

RESUMO

Chronic alcohol consumption results in multiple peripheral and central nervous system dysfunctions. Some are due to the direct action of alcohol or its derivatives, others are induced by the vitamin deficiencies associated with alcoholism, others are eventually related to the failure of other vital organs, such as the liver. In this short review, we describe alcohol-induced neuropathy, Gayet-Wernicke syndrome, Korsakoff syndrome, alcoholic dementia, Marchiafava-Bignami syndrome, hepatic encephalopathy, alcoholic epilepsy and manifestations of alcohol withdrawal.


Assuntos
Alcoolismo , Demência , Encefalopatia Hepática , Encefalopatia de Wernicke , Alcoolismo/complicações , Alcoolismo/fisiopatologia , Demência/complicações , Encefalopatia Hepática/complicações , Humanos , Encefalopatia de Wernicke/complicações
6.
Pract Neurol ; 19(4): 368-371, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048365

RESUMO

Portosystemic encephalopathy commonly occurs in patients with portal hypertension caused by end-stage liver disease or portal vein thrombosis. Congenital extrahepatic portosystemic shunt (CEPS) is an underdiagnosed and treatable condition that can cause encephalopathy and various neuropsychiatric symptoms. We report an unusual case of type 2 CEPS in a 29-year-old woman who presented with progressive myelopathy and fluctuating encephalopathy on a background of congenital cardiac disease. Investigations showed hyperammonaemia, and despite no evidence of portal hypertension on ultrasound imaging, CT scan of abdomen showed a shunt between the mesenteric and left internal iliac veins. Patients with unexplained fluctuating or progressive neuropsychiatric symptoms should have their serum ammonia checked. A raised serum ammonia concentration without known portal hypertension should prompt further investigations for extrahepatic shunts.


Assuntos
Encefalopatias/diagnóstico por imagem , Progressão da Doença , Encefalopatia Hepática/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Adulto , Encefalopatias/complicações , Feminino , Encefalopatia Hepática/complicações , Humanos , Doenças da Medula Espinal/complicações
7.
Dig Liver Dis ; 51(6): 850-855, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31031175

RESUMO

INTRODUCTION: Erectile dysfunction (ED) is common in patients with chronic diseases. It is evaluated using the International Index of Erectile Function (IIEF5) questionnaire. The relationship between ED and cirrhosis is complex. The aims of our study were (1) to assess the prevalence of ED in cirrhosis and (2) to evaluate factors associated with ED, with a special focus on minimal hepatic encephalopathy (MHE). METHODS: We performed a prospective, observational study. Patients with cirrhosis were invited to complete the IIEF5 questionnaire. The exclusion criteria were clinical hepatic encephalopathy (HE) and dementia. MHE was evaluated by the psychometric hepatic encephalopathy test score (PHES) and the critical flicker frequency (CFF). RESULTS: Between April 2016 and April 2017, 87 patients were included (age: 55 [51-57] years, Child-Pugh score: 8 [7-9], MELD score: 13 [11-16]. Minimal HE was diagnosed in 33% of the patients according to the PHES and in 44% of the patients according to the CFF. ED was diagnosed in 74/87 patients (85%) when compared to 12.5% in healthy controls (p < 0.001). In a multivariate analysis, the independent factors associated with ED were age, Child-Pugh and MELD scores. Significant correlations were identified between the IIEF5 and each component of the PHES. CONCLUSION: ED should be systematically screened in cirrhotics, especially in patients with MHE.


Assuntos
Disfunção Erétil/diagnóstico , Encefalopatia Hepática/complicações , Cirrose Hepática/complicações , Disfunção Erétil/etiologia , Fusão Flicker , Encefalopatia Hepática/patologia , Humanos , Cirrose Hepática/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença
8.
Chirurg ; 90(8): 614-620, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30963209

RESUMO

BACKGROUND: Esophageal variceal bleeding is a life-threatening complication in patients with liver cirrhosis, which is pathophysiologically explained by the presence of portal hypertension. The incidence of such bleeding greatly depends on the severity of the underlying liver disease. OBJECTIVE: The aim of this article is to present the current treatment concepts for acute esophageal variceal bleeding, the management in acute situations and the indications for treatment of the causal portal hypertension with a transjugular intrahepatic portosystemic shunt (TIPS). RESULTS: In patients with liver cirrhosis or any other disease causing portal hypertension, a staging examination by esophagogastroduodenoscopy is first carried out for determination of the stage of the varices and the resulting necessary treatment. In addition, determination of the portal pressure gradient is useful. In patients with varices a medicinal or endoscopic bleeding prophylaxis should subsequently additionally be initiated. After an acute variceal bleeding event, under clearly defined prerequisites an evaluation for TIPS implantation should be considered. This is the only effective treatment for reducing portal hypertension. CONCLUSION: With appropriate indications implantation of a TIPS is an effective strategy to lower portal hypertension and therefore prevent recurrent variceal bleeding. The resulting improvement of the portal hemodynamics leads to an improvement in kidney function; however, it also leads to deterioration of liver function with subsequent development or deterioration of a previously existing hepatic encephalopathy.


Assuntos
Varizes Esofágicas e Gástricas , Encefalopatia Hepática , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal , Encefalopatia Hepática/complicações , Humanos
9.
Brain Imaging Behav ; 13(3): 771-780, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29846883

RESUMO

A higher risk of cognitive impairments has been found after an overt hepatic encephalopathy (OHE) episode in cirrhotic patients. We investigated the effect of prior OHE episodes on the topological organization of the functional brain network and its association with the relevant cognitive impairments. Resting-state functional MRI data were acquired from 41 cirrhotic patients (19 with prior OHE (Prior-OHE) and 22 without (Non-Prior-OHE)) and 21 healthy controls (HC). A Psychometric Hepatic Encephalopathy Score (PHES) assessed cognition. The whole-brain functional network was constructed by thresholding functional correlation matrices of 90 brain regions (derived from the Automated Anatomic Labeling atlas). The topological properties of the brain network, including small-worldness, network efficiency, and nodal efficiency, were examined using graph theory-based analysis. Globally, the Prior-OHE group had a significantly decreased clustering coefficient and local efficiency, compared with the controls. Locally, the nodal efficiency in the bilateral medial superior frontal gyrus and the right postcentral gyrus decreased in the Prior-OHE group, while the nodal efficiency in the bilateral anterior cingulate/paracingulate gyri and right superior parietal gyrus increased in the Prior-OHE group. The alterations of global and regional network parameters progressed from Non-Prior-OHE to Prior-OHE and the clustering coefficient and local efficiency values were significantly correlated with PHES results. In conclusion, cirrhosis leads to the reduction of brain functional network efficiency, which could be aggravated by a prior OHE episode. Aberrant topological organization of the functional brain network may contribute to a higher risk of cognitive impairments in Prior-OHE patients.


Assuntos
Disfunção Cognitiva/fisiopatologia , Encefalopatia Hepática/fisiopatologia , Cirrose Hepática/fisiopatologia , Adulto , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Feminino , Giro do Cíngulo/fisiopatologia , Encefalopatia Hepática/complicações , Humanos , Cirrose Hepática/complicações , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Psicometria
10.
Liver Int ; 39(1): 106-114, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29931819

RESUMO

BACKGROUND & AIMS: The quantification of lipopolysaccharide (LPS) in biological fluids is challenging. We aimed to measure plasma LPS concentration using a new method of direct quantification of 3-hydroxymyristate (3-HM), a lipid component of LPS, and to evaluate correlations between 3-HM and markers of liver function, endothelial activation, portal hypertension and enterocyte damage. METHODS: Plasma from 90 noninfected cirrhotic patients (30 Child-Pugh [CP]-A, 30 CP-B, 30 CP-C) was prospectively collected. The concentration of 3-HM was determined by high-performance liquid chromatography coupled with mass spectrometry. RESULTS: 3-HM levels were higher in CP-C patients (CP-A/CP-B/CP-C: 68/70/103 ng/mL, P = 0.005). Patients with severe acute alcoholic hepatitis (n = 16; 113 vs 74 ng/mL, P = 0.012), diabetic patients (n = 22; 99 vs 70 ng/mL, P = 0.028) and those not receiving beta blockers (n = 44; 98 vs 72 ng/mL, P = 0.034) had higher levels of 3-HM. We observed a trend towards higher baseline levels of 3-HM in patients with hepatic encephalopathy (n = 7; 144 vs 76 ng/mL, P = 0.45) or SIRS (n = 10; 106 vs 75 ng/mL, P = 0.114). In multivariate analysis, high levels of 3-HM were associated with CP (OR = 4.39; 95%CI = 1.79-10.76) or MELD (OR = 8.24; 95%CI = 3.19-21.32) scores. Patients dying from liver insufficiency (n = 6) during a 12-month follow-up had higher baseline levels of 3-HM (106 vs 75 ng/mL, P = 0.089). CONCLUSIONS: In noninfected cirrhotic patients, 3-HM arises more frequently with impairment of liver function, heavy alcohol consumption, diabetic status, nonuse of beta blockers and a trend towards poorer outcome is also observed. The direct mass measurement of LPS using 3-HM appears reliable to detect transient endotoxaemia and promising to manage the follow-up of cirrhotic patients.


Assuntos
Análise Química do Sangue/métodos , Endotoxemia/diagnóstico , Lipopolissacarídeos/sangue , Cirrose Hepática/sangue , Ácidos Mirísticos/sangue , Idoso , Biomarcadores/sangue , Cromatografia Líquida de Alta Pressão , Feminino , Encefalopatia Hepática/sangue , Encefalopatia Hepática/complicações , Humanos , Cirrose Hepática/diagnóstico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos Piloto , Fatores de Risco , Índice de Gravidade de Doença
11.
Liver Int ; 39(1): 168-176, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30188604

RESUMO

BACKGROUND & AIMS: Familial aggregation of metabolic traits in NAFLD is well documented. However, relevance of these traits in alcoholic cirrhosis is not well studied. We aimed to explore the association of family history of metabolic traits with age at diagnosis, severity and complications of alcoholic cirrhosis. METHODS: In a cross-sectional study, all consecutive patients with alcoholic cirrhosis presenting to our tertiary care centre were included. Family and personal history, demographic characteristics, medical history, anthropometric measurements and laboratory data were recorded. The amount and duration of alcohol consumption were also carefully recorded. RESULTS: Out of 1084 alcoholic cirrhotics (age 48.5 ± 10.1 years, all males), family history for metabolic traits was documented in 688 (63.5%) patients. These patients had younger age at diagnosis, increased incidence of jaundice, ascites, variceal bleed and hepatic encephalopathy with consequently higher MELD and CTP score. These patients developed cirrhosis despite shorter median duration (13 years, IQR 7-20 vs 21, IQR 18-25) and lesser amount of alcohol consumption (74 g/d, IQR 24-96 vs 144, IQR 100-148). Patients with both family and personal history of metabolic traits had a higher risk by 3.3 times (95% CI 2.2-4.8) of an early age at diagnosis, 13.2 times (95% CI 8.7-20.1) of progression to cirrhosis with lesser amount of alcohol consumption and 4.6 times (95% CI 3.1-6.9) with lesser duration of alcohol consumption. CONCLUSIONS: Positive family and personal history of metabolic traits predispose to alcoholic cirrhosis with an earlier age at onset and more severity despite lesser exposure to alcohol.


Assuntos
Cirrose Hepática Alcoólica/complicações , Anamnese , Síndrome Metabólica/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Ascite/etiologia , Estudos Transversais , Progressão da Doença , Feminino , Predisposição Genética para Doença , Encefalopatia Hepática/complicações , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Índice de Gravidade de Doença , Centros de Atenção Terciária
12.
Br J Biomed Sci ; 76(1): 24-28, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30392460

RESUMO

OBJECTIVE: Hepatic encephalopathy is a common consequence of liver cirrhosis, but diagnosis can be difficult as it is based on clinical criteria alone. We hypothesised that serum prealbumin, cholinesterase and retinol binding protein (RBP) can help support the diagnosis of hepatic encephalopathy. METHODS: We enrolled 306 cirrhotic patients (110 with encephalopathy), 100 chronic hepatitis B patients and 50 healthy controls, measuring routine liver function tests (ALT, AST, GGT, ALP, and bilirubin), albumin, prothrombin time, prealbumin, cholinesterase and RBP by routine methods. Logistic regression analysis and areas under the receiver operating characteristic curves (AUCs) were used to find predictive factors for hepatic encephalopathy. RESULTS: There were differences in all laboratory indices between the three groups (all p < 0.001). In univariate analysis, albumin, prothrombin time, prealbumin, cholinesterase and RBP were significantly altered in those with encephalopathy (p < 0.01), but only prealbumin, cholinesterase and RBP levels were significant predictors in multivariate analysis, and each was linked to the severity of liver fibrosis defined by the Child-Pugh score (all p < 0.001). The AUCs (95% CI) of prealbumin, cholinesterase and RBP for diagnosing liver cirrhosis with hepatic encephalopathy were comparable at 0.85 (81-90), 0.81 (0.76-0.85) and 0.81 (0.76-0.86), respectively (all p < 0.01). CONCLUSIONS: Serum prealbumin, cholinesterase and RBP levels are of potential clinical value in diagnosis of liver cirrhosis complicated by encephalopathy.


Assuntos
Colinesterases/sangue , Encefalopatia Hepática/diagnóstico , Hepatite B/diagnóstico , Cirrose Hepática/diagnóstico , Pré-Albumina/metabolismo , Proteínas Celulares de Ligação ao Retinol/sangue , Adulto , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Encefalopatia Hepática/sangue , Encefalopatia Hepática/complicações , Encefalopatia Hepática/patologia , Hepatite B/sangue , Hepatite B/patologia , Hepatite B/virologia , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Tempo de Protrombina , Curva ROC , gama-Glutamiltransferase/sangue
13.
Am J Emerg Med ; 37(2): 329-337, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30414744

RESUMO

INTRODUCTION: Acute liver failure (ALF) remains a high-risk clinical presentation, and many patients require emergency department (ED) management for complications and stabilization. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of ALF. DISCUSSION: While ALF remains a rare clinical presentation, surveillance data suggest an overall incidence between 1 and 6 cases per million people every year, accounting for 6% of liver-related deaths and 7% of orthotopic liver transplants (OLT) in the U.S. The definition of ALF includes neurologic dysfunction, an international normalized ratio ≥ 1.5, no prior evidence of liver disease, and a disease course of ≤26 weeks, and can be further divided into hyperacute, acute, and subacute presentations. There are many underlying etiologies, including acetaminophen toxicity, drug induced liver injury, and hepatitis. Emergency physicians will be faced with several complications, including encephalopathy, coagulopathy, infectious processes, renal injury, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the transplant team for appropriate patients improves patient outcomes. This review provides several guiding principles for management of acute complications. Using a pathophysiological-guided approach to the management of ALF associated complications is essential to optimizing patient care. CONCLUSIONS: ALF remains a rare clinical presentation, but has significant morbidity and mortality. Physicians must rapidly diagnose these patients while evaluating for other diseases and complications. Early consultation with a transplantation center is imperative, as is identifying the underlying etiology and initiating symptomatic care.


Assuntos
Serviço Hospitalar de Emergência , Falência Hepática Aguda/diagnóstico , Falência Hepática Aguda/etiologia , Acetaminofen/toxicidade , Doença Hepática Induzida por Substâncias e Drogas/complicações , Encefalopatia Hepática/complicações , Hepatite/complicações , Humanos , Incidência , Falência Hepática Aguda/mortalidade , Falência Hepática Aguda/terapia , Transplante de Fígado
14.
ASN Neuro ; 10: 1759091418810583, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30428281

RESUMO

Hyperammonemia associated with overt hepatic encephalopathy (OHE) causes excitotoxic neuronal death through activation of the cytochrome C (CytC)-mediated mitochondria-dependent apoptotic pathway. We tested the therapeutic effect of nortriptyline (NT), a mitochondrial permeability transition pore (mPTP) blocker that can possibly inhibit mitochondrial CytC efflux to the cytosol on in vivo and in vitro OHE models. After ensuring the generation of OHE rats, established by bile duct ligation (BDL), they were intraperitoneally administered either 20 mg/kg NT (i.e., BDL+NT) or another vehicle (i.e., BDL+VEH) for 14 days. Compared with the control, BDL+VEH showed an increment of motor deficits, cell death, synaptic loss, apoptosis, and mitochondria with aberrant morphology in substantia nigra compacta dopaminergic (DA-ergic) neurons. However, the extent was significantly reversed in BDL+NT. Subsequently, we studied the neuroprotective mechanism of NT using PC-12 cells, a DA-ergic cell line, which exposed glutamate used as an excitotoxin. Compared with the control, the cells exposed to 15 mM glutamate (i.e., GLU) showed incremental cell death, apoptosis, and demise in mitochondrial respiration. Importantly, efflux of CytC from mitochondria to cytosol and the dissipation of mitochondrial membrane potential (△Ψm), an indicator of mPTP opening, were prominent in GLU. However, compared with the GLU, the cells cotreated with 10 µM NT (i.e., GLU+NT) showed a significant reduction in the aforementioned phenomenon. Together, we concluded that NT can be used for OHE therapeutics, mitigating the excitotoxic death of substantia nigra compacta DA-ergic neurons via mPTP-associated mitochondrial dysfunction inhibition.


Assuntos
Encefalopatia Hepática/complicações , Encefalopatia Hepática/tratamento farmacológico , Mitocôndrias/efeitos dos fármacos , Fármacos Neuroprotetores/uso terapêutico , Nortriptilina/uso terapêutico , Animais , Apoptose/efeitos dos fármacos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Comportamento Exploratório/efeitos dos fármacos , Ácido Glutâmico/farmacologia , Encefalopatia Hepática/patologia , Marcação In Situ das Extremidades Cortadas , Testes de Função Hepática , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Microscopia Eletrônica de Transmissão , Mitocôndrias/ultraestrutura , Atividade Motora/efeitos dos fármacos , Consumo de Oxigênio/efeitos dos fármacos , Células PC12/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley
15.
Molecules ; 23(11)2018 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-30380640

RESUMO

Swelling of retinal Müller cells is implicated in retinal edema and neuronal degeneration. Müller cell swelling is observed in patients with liver failure and is referred to as hepatic retinopathy. In the present study, we evaluated the effects of aloin, an anthraquinone-C-glycoside present in various Aloe species, on Müller cell dysfunction in a rat model of thioacetamide (TAA)-induced hepatic retinopathy. Experimental hepatic retinopathy was induced by three injections of TAA (200 mg/kg/day, intraperitoneal injection) for 3 days in rats. After the last injection of TAA, aloin (50 and 100 mg/kg) was orally gavaged for 5 days. The effects of aloin on the liver injury, serum ammonia levels, Müller cell swelling, glial fibrillary acidic protein (GFAP) expression, and gene expression of Kir4.1 and aquaporin-4 were examined. TAA-injected rats exhibited liver failure and hyperammonemia. In the TAA-injected rats, Müller cell bodies were highly enlarged, and GFAP, an indicator of retinal stress, was highly expressed in the retinas, indicating a predominant Müller cell gliosis. However, administration of aloin suppressed liver injury as well as Müller cell swelling through the normalization of Kir4.1 and aquaporin-4 channels, which play a key role in potassium and water transport in Müller cells. These results indicate that aloin may be helpful to protect retinal injury associated with liver failure.


Assuntos
Emodina/análogos & derivados , Células Ependimogliais/efeitos dos fármacos , Células Ependimogliais/patologia , Encefalopatia Hepática/complicações , Amônia/sangue , Animais , Aquaporina 4/genética , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Modelos Animais de Doenças , Emodina/farmacologia , Células Ependimogliais/metabolismo , Encefalopatia Hepática/induzido quimicamente , Encefalopatia Hepática/patologia , Fígado/efeitos dos fármacos , Fígado/patologia , Masculino , Canais de Potássio Corretores do Fluxo de Internalização/genética , Ratos Sprague-Dawley , Retina/efeitos dos fármacos , Retina/patologia , Degeneração Retiniana/tratamento farmacológico , Degeneração Retiniana/etiologia , Degeneração Retiniana/patologia , Tioacetamida/toxicidade
16.
Scand J Gastroenterol ; 53(9): 1107-1113, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30270689

RESUMO

OBJECTIVES: The clinical relevance of spontaneous portosystemic shunts detected by ultrasound is insufficiently investigated. The aim of this retrospective study was to assess the frequency and clinical relevance of spontaneous portosystemic shunts in patients with liver cirrhosis. METHODS: We evaluated portosystemic shunts, liver cirrhosis and spleen size by ultrasound in 982 patients with liver cirrhosis and correlated these with laboratory results, clinical data and the incidence of clinical endpoint deaths, liver transplantation and the development of HCC during the follow-up period (mean 1.26 ± 1.53 years [range 0-7.2 years]). RESULTS: Portosystemic shunts were detected in 34% of the patients. These patients had a higher rate of alcohol-related cirrhosis (37% vs. 30%, p = .003), a higher MELD score (p < .001) and Child-Pugh grade (p < .001), as well as more frequent hepatic encephalopathy (p < .001) and oesophageal varices (p < .003). The most frequent portosystemic shunt in this cohort was an umbilical vein shunt (69%) followed by splenorenal (16%), mesenteric (7%) and combined/other shunts (8%). Patients with umbilical vein shunts had a higher rate of alcohol-related cirrhosis (p = .041) and suffered more frequently from Child B/C stages (p = .03), hepatorenal syndrome (p = .03), massive ascites (p = .001) and spontaneous bacterial peritonitis (p = .011). CONCLUSIONS: Patients with portosystemic shunts that are detected by ultrasound should be monitored carefully as these patients are associated with advanced liver disease and multiple clinical risk factors.


Assuntos
Encefalopatia Hepática/complicações , Hipertensão Portal/diagnóstico por imagem , Cirrose Hepática/fisiopatologia , Baço/diagnóstico por imagem , Ultrassonografia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/complicações , Criança , Varizes Esofágicas e Gástricas/complicações , Feminino , Humanos , Hipertensão Portal/etiologia , Modelos Lineares , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
17.
Zhonghua Gan Zang Bing Za Zhi ; 26(7): 553-556, 2018 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-30317783

RESUMO

Hepatic encephalopathy (HE) is caused by severe liver disease or portal shunt. Metabolic disorders and central nervous system dysfunctions are the main symptoms of this syndrome. Ammonia is considered to play a central role in the pathogenesis of HE. Helicobacter pylori (H. pylori) have been suggested as a possible source of ammonia production because of its high urease content. However, the relationship between H.pylori and blood ammonia and HE, as well as the therapeutic effect of H.pylori eradication on HE, is inconclusive, and the results are full of contradictions. The aim of this review is to summarize current knowledge on the association of H. pylori with HE and to address the question of whether H. pylori eradication may be beneficial in the management of HE.


Assuntos
Amônia/análise , Infecções por Helicobacter/sangue , Helicobacter pylori/fisiologia , Encefalopatia Hepática/sangue , Cirrose Hepática/sangue , Infecções por Helicobacter/complicações , Encefalopatia Hepática/complicações , Humanos , Cirrose Hepática/complicações , Estômago/química
18.
Neuroimage Clin ; 20: 800-807, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30268989

RESUMO

Aberrant brain structural change in cirrhotic patients with or without hepatic encephalopathy is one of the most typical cases in voxel-based morphometry (VBM) studies. However, there exist inconsistent results regarding to the volume change of the thalamus. Furthermore, the relationship between thalamus structural change and cirrhotic symptoms has not yet been fully elucidated. To address these two issues, we repeated two VBM analyses in SPM and FreeSurfer and compared the two measurements with manually measured thalamic volumes. We also correlated the VBM results with clinical indexes related to cirrhosis to further investigate the relationship between thalamic structural change and liver cirrhosis. The inconsistent result of thalamic structural change was successfully reproduced in regard to the volume measurements of SPM and FreeSurfer. The manually measured results demonstrate an increase in the volume of the thalamus in cirrhotic patients compared to healthy controls, which differs from the results of FreeSurfer. The structural change of thalamus closely correlated with the blood biochemical indexes, including albumin levels, blood coagulation time, and AST/ALT ratio. All of these biochemical indexes are closely related to the severity of liver cirrhosis. Beyond all the results, this study also provides a good demonstration of the difference between multiple VBM measurements for clinicians.


Assuntos
Encefalopatia Hepática/patologia , Cirrose Hepática/complicações , Tálamo/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Encefalopatia Hepática/complicações , Encefalopatia Hepática/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Tálamo/diagnóstico por imagem
19.
Isr Med Assoc J ; 20(9): 533-538, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30221864

RESUMO

BACKGROUND: Magnesium is an essential intracellular cation. Magnesium deficiency is common in the general population and its prevalence among patients with cirrhosis is even higher. Correlation between serum levels and total body content is poor because most magnesium is intracellular. Minimal hepatic encephalopathy is a subclinical phase of hepatic encephalopathy with no overt symptoms. Cognitive exams can reveal minor changes in coordination, attention, and visuomotor function, whereas language and verbal intelligence are usually relatively spared. OBJECTIVES: To assess the correlation between intracellular and serum magnesium levels and minimal hepatic encephalopathy. METHODS: Outpatients with a diagnosis of compensated liver cirrhosis were enrolled in this randomized, double-blinded study. Patients were recruited for the study from November 2013 to January 2014, and were randomly assigned to a control (placebo) or an interventional (treated with magnesium oxide) group. Serum and intracellular magnesium levels were measured at enrollment and at the end of the study. Cognitive function was assessed by a specialized occupational therapist. RESULTS: Forty-two patients met the inclusion criteria, 29 of whom were included in this study. Among these, 83% had abnormal cognitive exam results compatible with minimal hepatic encephalopathy. While only 10% had hypomagnesemia, 33.3% had low levels of intracellular magnesium. Initial intracellular and serum magnesium levels positively correlated with cognitive performance. CONCLUSIONS: Magnesium deficiency is common among patients with compensated liver cirrhosis. We found an association between magnesium deficiency and impairment in several cognitive function tests. This finding suggests involvement of magnesium in the pathophysiology of minimal hepatic encephalopathy.


Assuntos
Transtornos Cognitivos/complicações , Encefalopatia Hepática/complicações , Cirrose Hepática/complicações , Deficiência de Magnésio/complicações , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/metabolismo , Método Duplo-Cego , Feminino , Encefalopatia Hepática/metabolismo , Humanos , Cirrose Hepática/metabolismo , Deficiência de Magnésio/metabolismo , Óxido de Magnésio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estudos Prospectivos
20.
Rev. esp. anestesiol. reanim ; 65(7): 394-397, ago.-sept. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-177135

RESUMO

Describimos un caso de trombosis cardíaca intraoperatoria durante una cirugía de trasplante ortotópico hepático que derivó en muerte intraoperatoria. Mediante ecocardiografía transesofágica, colocada durante la descompensación del paciente, se pudo determinar la causa del problema y observar con precisión el mecanismo de migración de trombos desde la circulación venosa hacia el corazón izquierdo


We describe a case of intraoperative cardiac trombosis during orthotopic liver transplant surgery that resulted in intraoperative death. By using transesophageal echocardiography, the cause of the descompensation of the patient could be determined and the mechanism of trombus migration from thrombi from the venous circulation to the left heart was accurately observed


Assuntos
Humanos , Masculino , Adulto , Tromboembolia/etiologia , Transplante de Fígado/efeitos adversos , Ecocardiografia Transesofagiana/métodos , Endocardite não Infecciosa/diagnóstico , Complicações Intraoperatórias , Síndrome Hepatorrenal/complicações , Síndrome Hepatopulmonar/complicações , Encefalopatia Hepática/complicações
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