Hepatik Aciller ve Hepatik Ensefalopati
Özet
Hastanın acil servise başvurusundaki ana şikayetin sarılık, bulantı, kusma, ishal, sağ üst kadran ağrısı, epigastrik ağrı, kaşıntı, anormal kanama, anormal morluk veya mental durum değişikliği olması karaciğer hastalığını akla getirmelidir. Ayrıntılı anamnez sonrasında; Alanin aminotransferaz(ALT), Aspartat aminotransferaz(AST), Alkalen fosfataz(ALP), direkt ve indirekt bilirubin, protrombin zamanı, albümin ve amonyak kan düzeyleri ile hepatik hastalık tanısına yönelik araştırma yapılır.
Kronik inflamatuar karaciğer hasarının 6 aydan uzun sürdüğü kronik hepatit hastalarının acil servis başvurusunda yakınma ve bulgulara göre asit, spontan bakteriyel peritonit, ensefalopati, koagülopati, varis kanaması gibi komplikasyonların tanı tedavi ve takibi yapılmalıdır.
Kronik karaciğer hastalığı olan hastalarda zihinsel ve davranışsal durum değişiklikleri, nöromüsküler bozukluklar gibi bulgularda hepatik ensefalopati tanısı akılda tutulmalıdır. Presipite edici faktörler araştırılıp tedavi edilmeli, laktüloz, L-ornitin-L-aspartat ve rifaksimin gibi ilaçlarla kan amonyak düzeyi düşürülmelidir.
Referanslar
Schaefer TJ. Acute Hepatitis. StatPearls. January 2022. (Ekim 2023 tarihinde. https://www.ncbi.nlm.nih.gov/books/NBK551570/ adresinden ulaşılmıştır.)
Marazzo J, Spach D. Hepatitis Web study. March 31, 2009. (Ekim 2023 tarihinde http://depts.washington.edu/hepstudy/index.html sitesinden ulaşılmıştır.)
Ryder SD, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis. BMJ. 2001 Jan 20;322(7279):151-3.
Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. American Journal of Gastroenterology 2017; 112:18.
Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut 2018; 67:6.
Ryder SD, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis. BMJ. 2001 Jan 20;322(7279):151-3.
Hosseini N, Shor J, Szabo G. Alcoholic Hepatitis: A Review. Alcohol Alcohol. 2019 Jul 01;54(4):408-416.
Montrief T, Koyfman A, Long B. Acute liver failure: A review for emergency physicians. Am J Emerg Med. 2019 Feb;37(2):329-337.
Wilson TR. The ABCs of hepatitis. The Nurse Practitioner. 2005 Jun;30(6):12-21, quiz 22-3.
Lee WM, Larson AM, Stravitz RT; American Association for the Study of Liver Diseases: Position paper: the management of acute liver failure; update (2011). Hepatology 55: 965, 2012.
Stravitz RT, Lee WM. Acute liver failure. Lancet. 2019 Sep 07;394(10201):869-881.
Bernardi M. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatology. 2017 May;66(5):1047-1081.
Bondesson JD, Saperston AR: Hepatitis. Emergency Medicine Clinic of North America 14: 695, 1996.
Sundaram V, Shaikh OS. Hepatic encephalopathy: pathophysiology and emerging therapies. Medical Clinics of North America 2009; 93:819.
Runyon BA: AASLD practice guideline: management of adult patients with ascites due to cirrhosis: update 2012. Hepatology 57: 1651, 2013.
Ge PS, Runyon BA. The changing role of the beta blocker therapy in patients with cirrhosis. J Hepatology 2014; 60:643
Mandorfer M, Bota S, Scwabl P, et al. Nonselective beta blokers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterila peritonitis. Gastroenterology 2014; 146:1680
Franca AV, De Souza JB, Silva CM, et al. Long-term prognosis of cirrhosis after spontaneous bacterial peritonitis treated with ceftriaxone. J Clinical Gastroenterology 33: 295, 2001.
Such J, Runyon BA. Spontaneous bacterial peritonitis. Clinical Infectious Diseases 1998; 27:669.
Mattos AA, Wiltgen D, Jotz RF, et al. Spontaneous bacterial peritonitis and extraperitoneal infections in patients with cirrhosis. Annals of Hepatology 2020; 19:451.
Runyon BA. Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology 1990; 12:710.
Hoefs JC, Runyon BA. Spontaneous bacterial peritonitis. Dis Mon 1985; 31:1
Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006; 34:1589.
Chavez-Tapia NC, Soares-Weiser K, Brezis M, et al: Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients. Cochrane Database Syst Rev 1: CD002232, 2009.
Romero-Gómez M, Boza F, García-Valdecasas MS, et al. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. American J Gastroenterology 2001; 96:2718.
Boyer TD, Haskal ZJ, American Association for the Study of Liver Diseases. The role of transjuguler intrahepatic portosystemic shunt in the management of portal hypertension, Hepatology 2005; 41:386.
Ong JP, Aggarwal A, Krieger D, et al. Correlation between ammonia levels and the severity of hepatic encephalopathy. The American Journal of Medicine 2003; 114:188.
Prabhakar S, Bhatia R. Management of agitation and convulsions in hepatic encephalopathy. Indian J Gastroenterology 2003; 22 Suppl 2:S54.
Goldbecker A, Buchert R, Berding G, et al. Blood-brain barrier permeability for ammonia in patients with different grades of liver fibrosis is not different from healthy controls. J Cereb Blood Flow Metab 2010; 30:1384.
James JH, Escourrou J, Fischer JE. Blood-brain neutral amino acid transport activity is increased after portacaval anastomosis. Science 1978; 200:1395.
Merli M, Lucidi C, Pentassuglio I, et al. Increased risk of cognitive impairment in cirrhotic patients with bacterial infections. J Hepatology 2013; 59:243.
Villanueva C, Albillos A, Genescà J, et al. Bacterial infections adversely influence the risk of decompensation and survival in compensated cirrhosis. J Hepatology 2021; 75:589.
Loffroy R, Favelier S, Pottecher P, et al. Transjugular intrahepatic portosystemic shunt for acute variceal gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging 2015; 96:745.
Nardelli S, Gioia S, Pasquale C, et al. Cognitive Impairment Predicts The Occurrence Of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt. The American Journal of Gastroenterology 2016; 111:523.
Bureau C, Thabut D, Jezequel C, et al. The Use of Rifaximin in the Prevention of Overt Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt : A Randomized Controlled Trial. Ann Intern Med 2021; 174:633.
Bajaj JS, Wade JB, Sanyal AJ. Spectrum of neurocognitive impairment in cirrhosis: Implications for the assessment of hepatic encephalopathy. Hepatology 2009; 50:2014.
Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60:715.
Gill RQ, Sterling RK. Acute liver failure. J Clinical Gastroenterology 2001; 33:191.
Cadranel JF, Lebiez E, Di Martino V, et al. Focal neurological signs in hepatic encephalopathy in cirrhotic patients: an underestimated entity? The American Journal of the Gastroenterology 2001; 96:515.
Ong JP, Aggarwal A, Krieger D, et al. Correlation between ammonia levels and the severity of hepatic encephalopathy. Am J Med 2003; 114:188.
Khungar V, Poordad F. Hepatic encephalopathy. Clin Liver Dis 2012; 16:301.
Mullen KD, Sanyal AJ, Bass NM, et al. Rifaximin is safe and well tolerated for long-term maintenance of remission from overt hepatic encephalopathy. Clin Gastroenterol Hepatol 2014; 12:1390.
Phongsamran PV, Kim JW, Cupo Abbott J, et al: Pharmacotherapy for hepatic encephalopathy. Drugs 70: 1131, 2010.
Prabhakar S, Bhatia R. Management of agitation and convulsions in hepatic encephalopathy. Indian J Gastroenterology 2003; 22 Suppl 2:S54.
Marazzo J, Spach D. Hepatitis Web study. March 31, 2009. (Ekim 2023 tarihinde http://depts.washington.edu/hepstudy/index.html sitesinden ulaşılmıştır.)
Ryder SD, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis. BMJ. 2001 Jan 20;322(7279):151-3.
Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. American Journal of Gastroenterology 2017; 112:18.
Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut 2018; 67:6.
Ryder SD, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis. BMJ. 2001 Jan 20;322(7279):151-3.
Hosseini N, Shor J, Szabo G. Alcoholic Hepatitis: A Review. Alcohol Alcohol. 2019 Jul 01;54(4):408-416.
Montrief T, Koyfman A, Long B. Acute liver failure: A review for emergency physicians. Am J Emerg Med. 2019 Feb;37(2):329-337.
Wilson TR. The ABCs of hepatitis. The Nurse Practitioner. 2005 Jun;30(6):12-21, quiz 22-3.
Lee WM, Larson AM, Stravitz RT; American Association for the Study of Liver Diseases: Position paper: the management of acute liver failure; update (2011). Hepatology 55: 965, 2012.
Stravitz RT, Lee WM. Acute liver failure. Lancet. 2019 Sep 07;394(10201):869-881.
Bernardi M. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatology. 2017 May;66(5):1047-1081.
Bondesson JD, Saperston AR: Hepatitis. Emergency Medicine Clinic of North America 14: 695, 1996.
Sundaram V, Shaikh OS. Hepatic encephalopathy: pathophysiology and emerging therapies. Medical Clinics of North America 2009; 93:819.
Runyon BA: AASLD practice guideline: management of adult patients with ascites due to cirrhosis: update 2012. Hepatology 57: 1651, 2013.
Ge PS, Runyon BA. The changing role of the beta blocker therapy in patients with cirrhosis. J Hepatology 2014; 60:643
Mandorfer M, Bota S, Scwabl P, et al. Nonselective beta blokers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterila peritonitis. Gastroenterology 2014; 146:1680
Franca AV, De Souza JB, Silva CM, et al. Long-term prognosis of cirrhosis after spontaneous bacterial peritonitis treated with ceftriaxone. J Clinical Gastroenterology 33: 295, 2001.
Such J, Runyon BA. Spontaneous bacterial peritonitis. Clinical Infectious Diseases 1998; 27:669.
Mattos AA, Wiltgen D, Jotz RF, et al. Spontaneous bacterial peritonitis and extraperitoneal infections in patients with cirrhosis. Annals of Hepatology 2020; 19:451.
Runyon BA. Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology 1990; 12:710.
Hoefs JC, Runyon BA. Spontaneous bacterial peritonitis. Dis Mon 1985; 31:1
Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006; 34:1589.
Chavez-Tapia NC, Soares-Weiser K, Brezis M, et al: Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients. Cochrane Database Syst Rev 1: CD002232, 2009.
Romero-Gómez M, Boza F, García-Valdecasas MS, et al. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. American J Gastroenterology 2001; 96:2718.
Boyer TD, Haskal ZJ, American Association for the Study of Liver Diseases. The role of transjuguler intrahepatic portosystemic shunt in the management of portal hypertension, Hepatology 2005; 41:386.
Ong JP, Aggarwal A, Krieger D, et al. Correlation between ammonia levels and the severity of hepatic encephalopathy. The American Journal of Medicine 2003; 114:188.
Prabhakar S, Bhatia R. Management of agitation and convulsions in hepatic encephalopathy. Indian J Gastroenterology 2003; 22 Suppl 2:S54.
Goldbecker A, Buchert R, Berding G, et al. Blood-brain barrier permeability for ammonia in patients with different grades of liver fibrosis is not different from healthy controls. J Cereb Blood Flow Metab 2010; 30:1384.
James JH, Escourrou J, Fischer JE. Blood-brain neutral amino acid transport activity is increased after portacaval anastomosis. Science 1978; 200:1395.
Merli M, Lucidi C, Pentassuglio I, et al. Increased risk of cognitive impairment in cirrhotic patients with bacterial infections. J Hepatology 2013; 59:243.
Villanueva C, Albillos A, Genescà J, et al. Bacterial infections adversely influence the risk of decompensation and survival in compensated cirrhosis. J Hepatology 2021; 75:589.
Loffroy R, Favelier S, Pottecher P, et al. Transjugular intrahepatic portosystemic shunt for acute variceal gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging 2015; 96:745.
Nardelli S, Gioia S, Pasquale C, et al. Cognitive Impairment Predicts The Occurrence Of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt. The American Journal of Gastroenterology 2016; 111:523.
Bureau C, Thabut D, Jezequel C, et al. The Use of Rifaximin in the Prevention of Overt Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt : A Randomized Controlled Trial. Ann Intern Med 2021; 174:633.
Bajaj JS, Wade JB, Sanyal AJ. Spectrum of neurocognitive impairment in cirrhosis: Implications for the assessment of hepatic encephalopathy. Hepatology 2009; 50:2014.
Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60:715.
Gill RQ, Sterling RK. Acute liver failure. J Clinical Gastroenterology 2001; 33:191.
Cadranel JF, Lebiez E, Di Martino V, et al. Focal neurological signs in hepatic encephalopathy in cirrhotic patients: an underestimated entity? The American Journal of the Gastroenterology 2001; 96:515.
Ong JP, Aggarwal A, Krieger D, et al. Correlation between ammonia levels and the severity of hepatic encephalopathy. Am J Med 2003; 114:188.
Khungar V, Poordad F. Hepatic encephalopathy. Clin Liver Dis 2012; 16:301.
Mullen KD, Sanyal AJ, Bass NM, et al. Rifaximin is safe and well tolerated for long-term maintenance of remission from overt hepatic encephalopathy. Clin Gastroenterol Hepatol 2014; 12:1390.
Phongsamran PV, Kim JW, Cupo Abbott J, et al: Pharmacotherapy for hepatic encephalopathy. Drugs 70: 1131, 2010.
Prabhakar S, Bhatia R. Management of agitation and convulsions in hepatic encephalopathy. Indian J Gastroenterology 2003; 22 Suppl 2:S54.
Sayfalar
19-34
Gelecek
29 Nisan 2024
Telif Hakkı (c) 2024 Akademisyen Yayınevi Kitap Portalı
Lisans
LisansNasıl Atıf Yapılır
1.
Yorulmaz F. Hepatik Aciller ve Hepatik Ensefalopati. Içinde: Kekeç Z, editör. Güncel Acil Tıp Çalışmaları V (Bahar) [Internet]. Türkiye: Akademisyen Yayınevi Kitap DOI Portalı; 2024 [a.yer 13 Temmuz 2026]. ss. 19-34. Erişim adresi: https://www.omp35.books.akademisyen.net/index.php/akya/catalog/book/3060/chapter/13437
