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انسفالوپاتی کبدی
Hepatic encephalopathy is another manifestation of advanced liver failure and is due to impaired hepatic clearance of gut- derived substances such as mercaptans and ammonia. ftese com- pounds, which are normally produced by intestinal flora, have sedating effects mediated by GABA receptors in the brain.
Hepatic encephalopathy is the result of numerous hepatic insults (e.g.
, dehydration, infections, gastrointestinal bleeding, hepati- cally metabolized medications) and may be seen in chronic and acute liver failure. fte degree of hepatic encephalopathy can be graded by the West Haven scale (Table 21-3).
hepatic encephalopathy centers on addressing the underlying cause of the hepatic decompensation and reducing excess intake of dietary protein and aromatic amino acids, but care must be taken to avoid malnutrition.
Rifaximin and other enteral antibiotics can treat hepatic encephalopathy by reducing the gut flora and the production of the compounds that cause hepatic encephalopathy.
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