Hepatik Ensefalopati

Hepatik ensefalopati (HE) akut veya kronik karaciğer hastalığına ve/veya porto-sitemik şanta sahip olan hastalarda görülen nöropsikiyatrik bir bozukluktur. Amonyak HE patogenezinde önemli bir role sahiptir, fakat inflamasyon, nörosteroidler, oksidatif stres ve manganez de bu hastalığın gelişiminde etkilidir. HE aşikar ve minimal olmak üzere iki gruba ayrılabilir. Aşikar HE klinik olarak teşhis edilebilir ve sirozlu ayaktan hastaların önemli bir kısmında bu hastalığın hafif-orta dereceleri görülebilir. Minimal HE'li hastalarda klinik muayenede mental ve nörolojik durum normaldir, fakat bazı özel psikometrik testler anormal sonuç verir. Amonyak seviyeleri hastalık şiddetini gösterebilen bir belirteç olmasına rağmen, HE teşhisinde sınırlı değere sahiptir. HE tedavisinin en iyi yöntemi altta yatan sebepleri tedavi etmektir. HE'nin başlangıç tedavisinde rifaksimin ve laktuloz gibi amonyağın üretimini ve gastrointestinal sistemden emilimini azaltan farmakolojik ajanlar esas olmalıdır.

Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a neuropsychiatric disorder seen in patients with acute or chronic liver disease and/or porto-systemic shunt. Ammonia has an important role in the pathogenesis of HE, but other factors such as inflammation, neurosteroids, oxidative stress, and manganese are also implicated in the development of the disease. HE can be classified as either 'overt'or 'minimal'. Overt HE can be diagnosed clinically and mild to moderate grades of the disease might be present in a considerable proportion of ambulatory patients with cirrhosis. The patients with minimal HE present with normal mental and neurological status upon clinical examination, but specific psychometric tests yield abnormal results. Serum levels of ammonia have limited value in the diagnosis of HE, despite being an indicator of disease severity. The best management of HE treatment is to treat the underlying causes. The initial treatment of HE is based on the principle of reducing the production and absorption of ammonia in the gut through administration of pharmacological agents such as rifaximin and lactulose.

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