Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

Abstract

Hepatic encephalopathy (HE) is a common complication in patients with advanced liver disease. It is a brain dysfunction characterized by neurological and psychiatric symptoms that significantly affects quality of life, morbidity and mortality of patients. HE has various precipitants that can potentially promote its onset, alone or in combination. Among the historically well-known precipitants, such as infections, gastrointestinal bleeding, dehydration, electrolyte disorders and constipation, recent studies have highlighted the role of malnutrition and portosystemic shunts as new precipitating factors of HE. The identification, management and correction of these factors are fundamental for effective HE treatment, in addition to pharmacological therapy with non-absorbable disaccharides and/or antibiotics.

The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia

“…The identification and correction of IDA have been emphasized as an essential part of comprehensive clinical management for CHF patients [ 8 ]. In addition to these findings, recent research has delved deeper into the intricacies of iron deficiency in heart failure in which a study on the nuanced relationship between iron metabolism and the pathophysiology of CHF elucidated that impaired iron homeostasis contributes significantly to the progression of heart failure [ 9 ]. This expanding body of evidence strongly supports the inclusion of routine assessment for IDA and targeted iron supplementation as a pivotal component of the holistic management of CHF patients, offering symptomatic relief and potential avenues for improving their overall cardiac function and prognosis.…”

Eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios mínimos

“…Existen múltiples enfermedades que alteran el estado de conciencia entre ellas se encuentran las siguientes (Bellafante et al, 2023):…”

Encefalopatia hepática no departamento de emergência

“…Foi demonstrado que a microbiota intestinal difere entre pacientes cirróticos e controles saudáveis. A microbiota fecal de pacientes com cirrose é caracterizada por uma maior prevalência de Alcaligenaceae, Porphyromonadaceae e Enterobacteriaceae, espécies fortemente associadas à cognição e à inflamação na EH (BELLAFANTE D, et al, 2023).…”

“…Os sintomas de EH em pacientes com cirrose hepática são múltiplos e compreendem funções motoras, sensoriais e cognitivas prejudicadas de gravidade variável. Embora esses sintomas sejam geralmente reversíveis, os distúrbios cognitivos podem não ser totalmente revertidos após a resolução da EH ( O diagnóstico de EH baseia-se nas características clínicas (asterixis, desorientação temporal e espacial, sonolência, alterações de personalidade, estupor e, finalmente, coma) e na exclusão de outras alterações neurológicas que possam mimetizar a EH, demência, meningoencefalite, hipercapnia, alterações eletrolíticas, psicose, intoxicação por drogas ou álcool, doença de Wilson e massas cerebrais (BELLAFANTE D, et al, 2023).…”