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Leverencefalopati

Sist revidert:
Sist revidert av:
Definisjon:
Leverencefalopati er nevropsykiatriske symptomer som oppstår ved leversykdom med portosystemisk shunting, det vil si ved levercirrhose og ved akutte leverskader. Endringene i hjernefunksjon skyldes metabolske forandringer
Forekomst:
Sjelden tilstand, men ikke uvanlig ved levercirrhose
Symptomer:
Personlighetsforandringer, intellektuelle forstyrrelser, nedsatt bevissthetsnivå og koma
Funn:
Foetor hepaticus, tremor, bradykinesi, hyperaktive senereflekser, ev. tegn på kronisk leversykdom
Diagnostikk:
Forhøyet ammonium, leverfunksjonsprøver viser betydelig nedsatt funksjon, EEG viser karakteristiske funn
Behandling:
Rettes mot utløsende årsaker og reduksjon av ammonium
  1. Ferenci P. Hepatic encephalopathy in adults: Clinical manifestations and diagnosis. UpToDate, last updated Feb 19, 2019. UpToDate  
  2. American Association for the Study of Liver Diseases, European Association for the Study of the Liver. Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. Journal of Hepatology 2014;61: 642-59. PubMed  
  3. Wolf DC. Hepatic encephalopathy. Medscape, last updated Apr 04, 2019. emedicine.medscape.com  
  4. Brusilow SW, Koehler RC, Traystman RJ, and Cooper AJ. Astrocyte glutamine synthetase: importance in hyperammonemic syndromes and potential target for therapy. Neurotherapeutics, 2010; 7:452–470.
  5. Amodio P, Montagnese S. Clinical neurophysiology of hepatic encephalopathy. J Clin Exp Hepatol 2015;5: S60-8. PubMed  
  6. Runyon BA. Hepatic encephalopathy in adults: Treatment. UpToDate, last updated May 17, 2023. UpToDate  
  7. Gluud LL, Vilstrup H, Morgan MY. Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD003044. DOI: 10.1002/14651858.CD003044.pub4. DOI  
  8. Sharma BC, Singh J, Srivastava S et al. A Randomized Controlled Trial Comparing Lactulose Plus Albumin versus Lactulose alone for Treatment of Hepatic Encephalopathy. J Gastroenterol Hepatol 2016. Epub ahead of print. pmid: 27885712 PubMed  
  9. Rahimi RS, Singal AG, Cuthbert JA, et al. Lactulose vs Polyethylene Glycol 3350-Electrolyte Solution for Treatment of Overt Hepatic Encephalopathy: The HELP Randomized Clinical Trial. JAMA Intern Med. 2014 Sep 22
  10. Bass NM, Mullen KD, Sanyal A, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med 2010 Mar 25;362(12):1071-81 PubMed  
  11. Sanyal A, Younossi ZM, Bass NM, et al. Randomised clinical trial: rifaximin improves health-related quality of life in cirrhotic patients with hepatic encephalopathy - a double-blind placebo-controlled study, Aliment Pharmacol Ther 2011 Oct;34(8):853-61.
  12. Sharma BC, Sharma P, Lunia MK, et al. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol 2013 Jul 23. doi: 10.1038/ajg.2013.219. DOI  
  13. Butterworth RF, McPhail MJW, L-Ornithine L-Aspartate (LOLA) for Hepatic Encephalopathy in Cirrhosis: Results of Randomized Controlled Trials and Meta-Analyses. Drugs 2019;79: 31-37 PubMed  
  14. López-Franco Ó, Morin JP, Cortés-Sol A, Molina-Jiménez T, Del Moral DI, Flores-Muñoz M, Roldán-Roldán G, Juárez-Portilla C, Zepeda RC, Cognitive Impairment After Resolution of Hepatic Encephalopathy: A Systematic Review and Meta-Analysis. Front Neurosci 2021;15: 579263 PubMed  
  • Terje Johannessen, professor i allmennmedisin, Trondheim

Tidligere fagmedarbeidere

  • Espen Dietrichs, professor og avdelingsoverlege, Universitetet i Oslo og Nevrologisk avdeling, Rikshospitalet, Oslo
  • Peter Nissen Bjerring, Overlæge, Klinisk Lektor, ph.d, Rigshospitalet, Afdeling for Tarmsvigt og Leversygdomme (Lægehåndbogen)