Understanding the impact of neurologic complications in patients with cirrhosis
Patients with cirrhosis may experience neurologic complications, including hepatic encephalopathy. Hepatic encephalopathy may be classified as covert (mild symptoms (e.g. lack of awareness)) or overt (moderate to severe symptoms (e.g. confusion or coma)), and symptoms may overlap with other neurolog...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-02-01
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| Series: | SAGE Open Medicine |
| Online Access: | https://doi.org/10.1177/2050312119832090 |
| _version_ | 1818290497471381504 |
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| author | Sanath K Allampati Kevin D Mullen |
| author_facet | Sanath K Allampati Kevin D Mullen |
| author_sort | Sanath K Allampati |
| collection | DOAJ |
| description | Patients with cirrhosis may experience neurologic complications, including hepatic encephalopathy. Hepatic encephalopathy may be classified as covert (mild symptoms (e.g. lack of awareness)) or overt (moderate to severe symptoms (e.g. confusion or coma)), and symptoms may overlap with other neurologic conditions (e.g. epilepsy, stroke). Managing hepatic encephalopathy includes identifying and treating precipitating factors (e.g. dehydration). First-line treatment for patients with overt hepatic encephalopathy is typically lactulose; to reduce the risk of overt hepatic encephalopathy recurrence, lactulose plus the nonsystemic antibiotic rifaximin is recommended. Rifaximin reduced the risk of breakthrough overt hepatic encephalopathy by 58% versus placebo over 6 months (p < 0.001; 91% of patients in each group were on concomitant lactulose). However, neither pharmacologic hepatic encephalopathy treatment nor liver transplantation may completely reverse neurologic impairment in patients with hepatic encephalopathy. Additional neurologic considerations for patients with cirrhosis include preventing falls, as well as managing sleep-related issues, hyponatremia, and cerebral edema. Thus, monitoring neurologic impairment is an important component in the management of patients with cirrhosis. |
| first_indexed | 2024-12-13T02:29:07Z |
| format | Article |
| id | doaj.art-70905523243449de984a85dbc2cf648e |
| institution | Directory Open Access Journal |
| issn | 2050-3121 |
| language | English |
| last_indexed | 2024-12-13T02:29:07Z |
| publishDate | 2019-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | SAGE Open Medicine |
| spelling | doaj.art-70905523243449de984a85dbc2cf648e2022-12-22T00:02:33ZengSAGE PublishingSAGE Open Medicine2050-31212019-02-01710.1177/2050312119832090Understanding the impact of neurologic complications in patients with cirrhosisSanath K AllampatiKevin D MullenPatients with cirrhosis may experience neurologic complications, including hepatic encephalopathy. Hepatic encephalopathy may be classified as covert (mild symptoms (e.g. lack of awareness)) or overt (moderate to severe symptoms (e.g. confusion or coma)), and symptoms may overlap with other neurologic conditions (e.g. epilepsy, stroke). Managing hepatic encephalopathy includes identifying and treating precipitating factors (e.g. dehydration). First-line treatment for patients with overt hepatic encephalopathy is typically lactulose; to reduce the risk of overt hepatic encephalopathy recurrence, lactulose plus the nonsystemic antibiotic rifaximin is recommended. Rifaximin reduced the risk of breakthrough overt hepatic encephalopathy by 58% versus placebo over 6 months (p < 0.001; 91% of patients in each group were on concomitant lactulose). However, neither pharmacologic hepatic encephalopathy treatment nor liver transplantation may completely reverse neurologic impairment in patients with hepatic encephalopathy. Additional neurologic considerations for patients with cirrhosis include preventing falls, as well as managing sleep-related issues, hyponatremia, and cerebral edema. Thus, monitoring neurologic impairment is an important component in the management of patients with cirrhosis.https://doi.org/10.1177/2050312119832090 |
| spellingShingle | Sanath K Allampati Kevin D Mullen Understanding the impact of neurologic complications in patients with cirrhosis SAGE Open Medicine |
| title | Understanding the impact of neurologic complications in patients with cirrhosis |
| title_full | Understanding the impact of neurologic complications in patients with cirrhosis |
| title_fullStr | Understanding the impact of neurologic complications in patients with cirrhosis |
| title_full_unstemmed | Understanding the impact of neurologic complications in patients with cirrhosis |
| title_short | Understanding the impact of neurologic complications in patients with cirrhosis |
| title_sort | understanding the impact of neurologic complications in patients with cirrhosis |
| url | https://doi.org/10.1177/2050312119832090 |
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