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Erschienen in: Intensivmedizin und Notfallmedizin 8/2010

01.11.2010 | Leitthema

Hepatische Enzephalopathie

verfasst von: A. Tryc, A. Goldbecker, Prof. Dr. K. Weissenborn

Erschienen in: Intensivmedizin und Notfallmedizin | Ausgabe 8/2010

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Zusammenfassung

Die hepatische Enzephalopathie (HE) ist eine der häufigsten Komplikationen der Leberzirrhose. Im vorliegenden Beitrag werden die klinische Symptomatik, die Pathophysiologie, die Diagnosestellung und die Differenzialdiagnose sowie die Therapie der hepatischen Enzephalopathie beschrieben. Zusätzlich wird auf die Bedeutung der sog. minimalen hepatischen Enzephalopathie eingegangen und deren Diagnostik erläutert.
Literatur
1.
Zurück zum Zitat Ahl B, Weissenborn K, Hoff J van den et al (2004) Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis. Hepatology 40:73–79CrossRefPubMed Ahl B, Weissenborn K, Hoff J van den et al (2004) Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis. Hepatology 40:73–79CrossRefPubMed
2.
Zurück zum Zitat Bajaj JS, Saeian K, Schubert CM et al (2009) Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test. Hepatology 50:1175–1183CrossRefPubMed Bajaj JS, Saeian K, Schubert CM et al (2009) Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test. Hepatology 50:1175–1183CrossRefPubMed
3.
Zurück zum Zitat Bass NM, Mullen KD, Sanyal A et al (2010) Rifaximin treatment in hepatic encephalopathy. N Engl J Med 362:1071–1081CrossRefPubMed Bass NM, Mullen KD, Sanyal A et al (2010) Rifaximin treatment in hepatic encephalopathy. N Engl J Med 362:1071–1081CrossRefPubMed
4.
Zurück zum Zitat Butterworth RF, Spahr L, Fontaine S et al (1995) Manganese toxicity, dopaminergic dysfunction and hepatic encephalopathy. Metab Brain Dis 10(4):259–27CrossRefPubMed Butterworth RF, Spahr L, Fontaine S et al (1995) Manganese toxicity, dopaminergic dysfunction and hepatic encephalopathy. Metab Brain Dis 10(4):259–27CrossRefPubMed
5.
Zurück zum Zitat Conn HO, Lieberthal MM (1978) Assessment of mental state. In: Conn HO, Lieberthal MM (Hrsg) The hepatic coma syndromes and lactulose. Williams & Wilkins, Baltimore, S 169–188 Conn HO, Lieberthal MM (1978) Assessment of mental state. In: Conn HO, Lieberthal MM (Hrsg) The hepatic coma syndromes and lactulose. Williams & Wilkins, Baltimore, S 169–188
6.
Zurück zum Zitat Cordoba J, Lopez-Hellin J, Planas M et al (2004) Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 41:38–43CrossRefPubMed Cordoba J, Lopez-Hellin J, Planas M et al (2004) Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 41:38–43CrossRefPubMed
7.
Zurück zum Zitat Dhiman RK, Kurmi R, Thumburu KK et al (2010) Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver. Dig Dis Sci 55(8):2381–2390CrossRefPubMed Dhiman RK, Kurmi R, Thumburu KK et al (2010) Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver. Dig Dis Sci 55(8):2381–2390CrossRefPubMed
8.
Zurück zum Zitat Ferenci P, Lockwood A, Mullen K et al (2002) Hepatic encephalopathy – definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721CrossRefPubMed Ferenci P, Lockwood A, Mullen K et al (2002) Hepatic encephalopathy – definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721CrossRefPubMed
9.
Zurück zum Zitat Groeneweg M, Quero JC, De Bruijn I et al (1988) Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 28:45–49CrossRef Groeneweg M, Quero JC, De Bruijn I et al (1988) Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 28:45–49CrossRef
10.
Zurück zum Zitat Häussinger D, Schliess F (2008) Pathogenetic mechanisms of hepatic encephalopathy. Gut 57:1156–1165CrossRefPubMed Häussinger D, Schliess F (2008) Pathogenetic mechanisms of hepatic encephalopathy. Gut 57:1156–1165CrossRefPubMed
11.
Zurück zum Zitat Jayakumar AR, Rama Rao KV, Kalaiselvi P et al (2004) Combined effects of ammonia and manganese on astrocytes in culture. Neurochem Res 29(11):2051–2056CrossRefPubMed Jayakumar AR, Rama Rao KV, Kalaiselvi P et al (2004) Combined effects of ammonia and manganese on astrocytes in culture. Neurochem Res 29(11):2051–2056CrossRefPubMed
12.
Zurück zum Zitat Jepsen P, Ott P, Andersen PK et al (2010) Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology 51:1675–1682CrossRefPubMed Jepsen P, Ott P, Andersen PK et al (2010) Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology 51:1675–1682CrossRefPubMed
13.
Zurück zum Zitat Kale RA, Gupta RK, Saraswat VA et al (2006) Demonstration of interstitial cerebral edema with diffusion tensor MR imaging in type C hepatic encephalopathy. Hepatology 43:698–706CrossRefPubMed Kale RA, Gupta RK, Saraswat VA et al (2006) Demonstration of interstitial cerebral edema with diffusion tensor MR imaging in type C hepatic encephalopathy. Hepatology 43:698–706CrossRefPubMed
14.
Zurück zum Zitat Kircheis G, Wettstein M, Timmermann L et al (2002) Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology 35:357–366CrossRefPubMed Kircheis G, Wettstein M, Timmermann L et al (2002) Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology 35:357–366CrossRefPubMed
15.
Zurück zum Zitat Kircheis G, Knoche A, Hilger N et al (2009) Hepatic encephalopathy and fitness to drive. Gastroenterology 137:1706–1715CrossRefPubMed Kircheis G, Knoche A, Hilger N et al (2009) Hepatic encephalopathy and fitness to drive. Gastroenterology 137:1706–1715CrossRefPubMed
16.
Zurück zum Zitat Krieger S, Jauß M, Jansen O et al (1996) Neuropsychiatric profile and hyperintense globus pallidus on T1-weighted magnetic resonance images in liver cirrhosis. Gastroenterology 111:147–155CrossRefPubMed Krieger S, Jauß M, Jansen O et al (1996) Neuropsychiatric profile and hyperintense globus pallidus on T1-weighted magnetic resonance images in liver cirrhosis. Gastroenterology 111:147–155CrossRefPubMed
17.
Zurück zum Zitat Lockwood AH, Weissenborn K, Butterworth RF (1997) An image of the brain in patients with liver disease. Curr Opin Neurol 10(6):525–533CrossRefPubMed Lockwood AH, Weissenborn K, Butterworth RF (1997) An image of the brain in patients with liver disease. Curr Opin Neurol 10(6):525–533CrossRefPubMed
18.
Zurück zum Zitat Lockwood AH (2000) What’s in a name? Improving the care of cirrhotics. J Hepatol 32:859–861CrossRefPubMed Lockwood AH (2000) What’s in a name? Improving the care of cirrhotics. J Hepatol 32:859–861CrossRefPubMed
19.
Zurück zum Zitat Marchesini G, Bianchi G, Merli M et al (2003) Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 124:1792–1801CrossRefPubMed Marchesini G, Bianchi G, Merli M et al (2003) Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 124:1792–1801CrossRefPubMed
20.
Zurück zum Zitat Muto Y, Sato S, Watanabe A et al (2005) Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol 3:705–713CrossRefPubMed Muto Y, Sato S, Watanabe A et al (2005) Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol 3:705–713CrossRefPubMed
21.
Zurück zum Zitat Plum F, Hindfelt B (1976) The neurological complications of liver disease. In: Vinken P, Bruyn DF (Hrsg) Handbook of clinical neurology, Bd 27. Elsevier, Amsterdam, S 349–377 Plum F, Hindfelt B (1976) The neurological complications of liver disease. In: Vinken P, Bruyn DF (Hrsg) Handbook of clinical neurology, Bd 27. Elsevier, Amsterdam, S 349–377
22.
Zurück zum Zitat Prasad S, Dhiman RK, Duseja A et al (2007) Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology 45(3):549–559CrossRefPubMed Prasad S, Dhiman RK, Duseja A et al (2007) Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology 45(3):549–559CrossRefPubMed
23.
Zurück zum Zitat Quadri AM, Ogunwale BO, Mullen KD (2007) Can we ignore minimal hepatic encephalopathy any longer? Hepatology 45:547–548CrossRef Quadri AM, Ogunwale BO, Mullen KD (2007) Can we ignore minimal hepatic encephalopathy any longer? Hepatology 45:547–548CrossRef
24.
Zurück zum Zitat Randolph C, Hilsabeck R, Kato A et al (2009) Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int 29(5):629–635CrossRefPubMed Randolph C, Hilsabeck R, Kato A et al (2009) Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int 29(5):629–635CrossRefPubMed
25.
Zurück zum Zitat Read A, Sherlock S, Laidlaw J et al (1967) The neuro-psychiatric syndromes associated with chronic liver disease and an extensive portal-systemic collateral circulation. Q J Med XXXVI(114):135–150 Read A, Sherlock S, Laidlaw J et al (1967) The neuro-psychiatric syndromes associated with chronic liver disease and an extensive portal-systemic collateral circulation. Q J Med XXXVI(114):135–150
26.
Zurück zum Zitat Rose C, Butterworth RF, Zayed J et al (1999) Manganese deposition in basal ganglia structures results from both portal-systemic shunting and liver dysfunction. Gastroenterology 117:640–644CrossRefPubMed Rose C, Butterworth RF, Zayed J et al (1999) Manganese deposition in basal ganglia structures results from both portal-systemic shunting and liver dysfunction. Gastroenterology 117:640–644CrossRefPubMed
27.
Zurück zum Zitat Schomerus H, Hamster W, Blunck H et al (1981) Latent portasystemic encephalopathy: I. Nature of cerebral functional defects and their effect on fitness to drive. Dig Dis Sci 26:622–630CrossRefPubMed Schomerus H, Hamster W, Blunck H et al (1981) Latent portasystemic encephalopathy: I. Nature of cerebral functional defects and their effect on fitness to drive. Dig Dis Sci 26:622–630CrossRefPubMed
28.
Zurück zum Zitat Schomerus H, Weissenborn K, Hamster W et al (1999) PSE-Syndrom-Test. Swets Test Services. Swets & Zeitlinger B.V, Frankfurt Schomerus H, Weissenborn K, Hamster W et al (1999) PSE-Syndrom-Test. Swets Test Services. Swets & Zeitlinger B.V, Frankfurt
29.
Zurück zum Zitat Schomerus H, Hamster W (1998) Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis 13(4):361–377CrossRefPubMed Schomerus H, Hamster W (1998) Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis 13(4):361–377CrossRefPubMed
30.
Zurück zum Zitat Sharma BC, Sharma P, Agarwal A et al (2009) Secondary prophylaxis of hepatic encephalopathy: an open label randomized controlled trial of lactulose versus placebo. Gastroenterology 137:885–891CrossRefPubMed Sharma BC, Sharma P, Agarwal A et al (2009) Secondary prophylaxis of hepatic encephalopathy: an open label randomized controlled trial of lactulose versus placebo. Gastroenterology 137:885–891CrossRefPubMed
31.
Zurück zum Zitat Shawcross DL, Balata S, Olde-Damink SW et al (2004) Low myoinositol and high glutamine levels in brain are associated with neuropsychological deterioration after induced hyperammonemia. Am J Physiol 287:G503–G509 Shawcross DL, Balata S, Olde-Damink SW et al (2004) Low myoinositol and high glutamine levels in brain are associated with neuropsychological deterioration after induced hyperammonemia. Am J Physiol 287:G503–G509
32.
Zurück zum Zitat Uribe M, Campollo O, Vargas F et al (1987) Acidifying enemas (lactitol and lactose) vs. nonacidifying enemas (tap water) to treat acute portal-systemic encephalopathy: a double-blind randomized clinical trial. Hepatology 7:639–643CrossRefPubMed Uribe M, Campollo O, Vargas F et al (1987) Acidifying enemas (lactitol and lactose) vs. nonacidifying enemas (tap water) to treat acute portal-systemic encephalopathy: a double-blind randomized clinical trial. Hepatology 7:639–643CrossRefPubMed
33.
Zurück zum Zitat Wein C, Koch H, Popp B et al (2004) Minimal hepatic encephalopathy impairs fitness to drive. Hepatology 39:739–745CrossRefPubMed Wein C, Koch H, Popp B et al (2004) Minimal hepatic encephalopathy impairs fitness to drive. Hepatology 39:739–745CrossRefPubMed
34.
Zurück zum Zitat Weissenborn K (1991) Neurophysiological methods in the diagnosis of early hepatic encephalopathy. In: Bengtsson F, Jeppsson B, Almdal T, Vilstrup H (Hrsg) Progress in hepatic encephalopathy and metabolic nitrogen exchange. CRC Press, Boca Raton, S 27–39 Weissenborn K (1991) Neurophysiological methods in the diagnosis of early hepatic encephalopathy. In: Bengtsson F, Jeppsson B, Almdal T, Vilstrup H (Hrsg) Progress in hepatic encephalopathy and metabolic nitrogen exchange. CRC Press, Boca Raton, S 27–39
35.
Zurück zum Zitat Weissenborn K, Ennen J, Schomerus H et al (2001) Neuropsychological characterisation of hepatic encephalopathy. J Hepatol 34(5):768–773CrossRefPubMed Weissenborn K, Ennen J, Schomerus H et al (2001) Neuropsychological characterisation of hepatic encephalopathy. J Hepatol 34(5):768–773CrossRefPubMed
Metadaten
Titel
Hepatische Enzephalopathie
verfasst von
A. Tryc
A. Goldbecker
Prof. Dr. K. Weissenborn
Publikationsdatum
01.11.2010
Verlag
Springer-Verlag
Erschienen in
Intensivmedizin und Notfallmedizin / Ausgabe 8/2010
Print ISSN: 0175-3851
Elektronische ISSN: 1435-1420
DOI
https://doi.org/10.1007/s00390-010-0189-y

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