1. EMedicine - Portal-Systemic Encephalopathy : Article By Blake A Jones, MD portalsystemic encephalopathy - Portosystemic encephalopathy (PSE) is aneuropsychiatric syndrome associated with advanced liver disease. http://www.emedicine.com/med/topic1890.htm

(advertisement) Home Specialties Resource Centers CME ... Patient Education Articles Images CME Patient Education Advanced Search Consumer Health Link to this site Back to: eMedicine Specialties Medicine, Ob/Gyn, Psychiatry, and Surgery Gastroenterology Portal-Systemic Encephalopathy Last Updated: January 8, 2003 Rate this Article Email to a Colleague Synonyms and related keywords: portosystemic encephalopathy, PSE, hepatic encephalopathy, HE, liver disease, advanced liver disease, portosystemic shunt, portal-systemic shunt, neurotoxicity, neuropsychosis, hyperammonemia, transjugular intrahepatic portosystemic shunt, TIPS, nonselective portocaval shunts AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials ... Bibliography Author: Blake A Jones, MD , New Hampshire Gastroenterology Blake A Jones, MD, is a member of the following medical societies: American Association for the Study of Liver Diseases American College of Gastroenterology American Gastroenterological Association American Medical Association ... Royal College of Physicians and Surgeons of Canada , and Texas Medical Association Editor(s): Ann Ouyang, MBBS

2. EMedicine - Portal-Systemic Encephalopathy Article By Blake A portalsystemic encephalopathy - Portosystemic encephalopathy (PSE) is a neuropsychiatric syndrome associated with advanced liver disease. http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

3. THE MERCK MANUAL, Sec. 4, Ch. 38, Clinical Features Of Liver Disease portalsystemic encephalopathy is a more descriptive term of the Portal-systemicencephalopathy may occur in fulminant hepatitis caused by viruses, http://www.merck.com/mrkshared/mmanual/section4/chapter38/38f.jsp

4. EMedicine - Portal-Systemic Encephalopathy Article Excerpt By portalsystemic encephalopathy - Portosystemic encephalopathy (PSE) is a neuropsychiatric syndrome associated with advanced liver disease. http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

5. THE MERCK MANUAL, Sec. 4, Ch. 38, Clinical Features Of Liver Disease portalsystemic encephalopathy and ascites are the other major consequences ofportal hypertension (see below). Splenomegaly and hypersplenism commonly http://www.merck.com/mrkshared/mmanual/section4/chapter38/38d.jsp

6. Portal-Systemic Encephalopathy portalsystemic encephalopathy. Date Sat, 24 Jun 2000 091732 -0700 From hbv_research-list-owners@mail-list.com.. . http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

7. THE MERCK MANUAL, Sec. 4, Ch. 38, Clinical Features Of Liver Disease portalsystemic encephalopathy (Hepatic Encephalopathy; Hepatic Coma) A neuropsychiatric syndrome caused by liver disease and usually associated http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

8. Portal-systemic Encephalopathy In Non-cirrhotic Patients portalsystemic encephalopathy in non-cirrhotic patients Classification of clinical types, diagnosis and treatment http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

9. Best Practice Medicine-Professional Reference - Portal-systemic Hepatology, portalsystemic encephalopathy. portal-systemic encephalopathyis a common disorder in patients with liver disease that manifests a wide http://merck.micromedex.com/index.asp?page=bpm_brief&article_id=CPM02HP377

10. Effect Of Dietary Protein Manipulation In Subclinical Effect of dietary protein manipulation in subclinical portalsystemic encephalopathy http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

11. Treatment Of Chronic Portalsystemic Encephalopathy With Treatment of chronic portalsystemic encephalopathy with vegetable and animal protein diets. A controlled crossover study. http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

12. Entrez PubMed Hepatic encephalopathy is suspected in noncirrhotic cases of encephalopathybecause the symptoms ar http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1

13. Best Practice Of Medicine -Portal-systemic Encephalopathy - Print . The pathogenesis of portalsystemic encephalopathy arises from the portal-systemic shunting of blood and hepatic dysfunction. http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

14. Entrez PubMed in 45 episodes of acute nitrogenous portalsystemic encephalopathy (PSE)induced by dietary protein, azotemia, or gastrointestinal hemorrhage. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3

15. Webkatalog prolet1 wie das Vertrauen zur honney Sie sind hier Startseite Fit Gesund Webkatalog. Hepatic Encephalopathy Websites http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

16. Arch Neurol -- Abstract: Histochemical Studies In Experimental Portal-systemic E Histochemical studies in experimental portalsystemic encephalopathy. MD Norenberg.Results of a histochemical study of glutamic dehydrogenase in http://archneur.ama-assn.org/cgi/content/abstract/33/4/265

Select Journal or Resource JAMA Archives of Dermatology Facial Plastic Surgery Family Medicine (1992-2000) General Psychiatry Internal Medicine Neurology Ophthalmology Surgery Student JAMA (1998-2004) JAMA CareerNet For The Media Meetings Peer Review Congress Vol. 33 No. 4, April 1976 Featured Link E-mail Alerts ARTICLE Article Options Send to a Friend Readers Reply Submit a reply Similar articles in this journal Literature Track Add to File Drawer Download to Citation Manager PubMed citation Articles in PubMed by Norenberg MD Contact me when this article is cited Histochemical studies in experimental portal-systemic encephalopathy M. D. Norenberg Results of a histochemical study of glutamic dehydrogenase in experimental portal-systemic encephalopathy with hyperammonemia indicate that the enzyme's activity in brain was increased in all stages of the encephalopathy, and this increase appeared to be localized exclusively in astrocytes. The results are consistent with the view that the astrocyte has a critical role in ammonia metabolism in brain, probably in ammonia

17. Arch Neurol Abstract Histochemical Studies In Experimental Histochemical studies in experimental portalsystemic encephalopathy. M. D. Norenberg http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

18. Effect Of Dietary Protein Manipulation In Subclinical Portal-systemic Encephalop patients with mild or subclinical portal systemic encephalopathy (PSE) were test to monitor methods of treatment in portal-systemic encephalopathy. http://gut.bmjjournals.com/cgi/content/abstract/24/1/53

HOME HELP FEEDBACK SUBSCRIPTIONS ... TABLE OF CONTENTS Author Keyword(s) Vol Page [Advanced] This Article Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal ... Cited by other online articles PubMed PubMed Citation Articles by de Bruijn, K. M. Articles by Anderson, G. H. PAPERS Effect of dietary protein manipulation in subclinical portal-systemic encephalopathy KM de Bruijn, LM Blendis, DH Zilm, PL Carlen and GH Anderson Eight stable cirrhotic patients with mild or subclinical portal- systemic encephalopathy (PSE) were studied after shunt surgery when they were off all antiencephalopathic therapy. Equal amounts of mixed proteins were alternated with animal or vegetable protein in a crossover protocol under metabolic conditions for five consecutive, one week periods. The different

19. Postgraduate Medicine: Hepatic Encephalopathy Often, the term portalsystemic encephalopathy is used to emphasize the failure The pathogenesis of portal-systemic hepatic encephalopathy probably is http://www.postgradmed.com/issues/2001/02_01/assi.htm

Hepatic encephalopathy Metabolic consequence of cirrhosis often is reversible Souheil Abou-Assi, MD; Z. Reno Vlahcevic, MD* VOL 109 / NO 2 / FEBRUARY 2001 / POSTGRADUATE MEDICINE CME learning objectives To understand the pathogenesis of hepatic encephalopathy in chronic liver disease To recognize the clinical manifestations and diagnostic tools used to detect hepatic encephalopathy To be aware of the precipitating factors for hepatic encephalopathy and to try to avoid them in patients with cirrhosis The authors disclose no financial interests in this article. Supported by a grant from the National Institutes of Health and a grant from the Department of Veterans Affairs. *Deceased. This is the first of three articles on cirrhosis This page is best viewed with a browser that supports tables. Preview : Hepatic encephalopathy is characterized by neuropsychiatric manifestations ranging from a slightly altered mental status to coma, and neuromuscular symptoms may be present. This complication of chronic or acute liver disease is a result of the failure of the liver to detoxify toxins originating in the intestine. The pathogenesis probably is multifactorial, although the predominant causative agent appears to be ammonia. In this article, Drs Abou-Assi and Vlahcevic discuss the timely recognition and correction of factors contributing to this often reversible condition. Abou-Assi S, Vlahcevic ZR. Hepatic encephalopathy: metabolic consequence of cirrhosis often is reversible. Postgrad Med 2001;109(2):52-70

20. Data Sheet In the treatment of chronic portalsystemic encephalopathy studies have shown In the overall management of portal-systemic encephalopathy it should be http://www.medsafe.govt.nz/Profs/Datasheet/a/Alphalactulosesyrup.htm

Data Sheet ALPHA-LACTULOSE Lactulose 3.34g/5mL Presentation Uses Actions Lactulose is a synthetic disaccharide used in the treatment of constipation and in hepatic encephalopathy. Studies in patients with a history of chronic constipation have shown that lactulose therapy causes a significant increase in the number of bowel movements per day and the number of days on which bowel movements occur. Lactulose reaches the colon virtually unchanged. There it is metabolised by colonic bacteria to lactic acid and other shortchain carboxylic acids. The end result is a change in the osmotic pressure and acidification of the colonic contents resulting in an increase in stool water content with resultant distention and softening of the stool which in turn promotes increased peristalsis and bowel evacuation. It may take 48 hours before an effect is obtained. The therapeutic action of lactulose in ameliorating the symptoms of hepatic encephalopathy is considered to be a result of the following: Reduction of faecal pH leading to a reduced ammonia absorption via nonionic diffusion and/or diffusion of ammonia from the blood into the gut. The trapped ammonia is then excreted in the stools. Suppression of urase producing organisms Induction of an osmotic type of diarrhoea which diminishes faecal statis with reduction of nitrogenous substances for ammonia production. Decreased absorption of ammonia from the gut also results from shortening intestinal transit time.

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