• Title/Summary/Keyword: hepatic encephalopathy

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A Case of Congenital Extra Hepatic Portocaval Shunt (Abernethy Malformation Type 2) with a very Large Liver Mass and an Atrial Septal Defect (거대 간 종괴와 심방 중격 결손을 동반한 Abernethy 기형 2형 1예)

  • Lee, Hae-Jeong;Lee, Jee-Hyun;Huh, June;Kang, I-Seok;Lee, Heung-Jae;Suh, Yeon-Lim;Yoo, So-Young;Choe, Yon-Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.1
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    • pp.56-59
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    • 2008
  • Extrahepatic portosystemic shunts, known as Abernethy malformations, were first reported by John Abernethy in 1793. They are classified into two types: Type I refers to a congenital absence of the portal vein and Type II refers to a shunt involving a side-to-side anastomosis with reduced portal blood flow into the liver parenchyma. This malformation is so rare that less than 100 cases have been reported in the medical literature. We report the case of a 13-month-old boy who had a congenital extrahepatic portocaval shunt with a hypoplastic portal vein. This case was complicated with an atrial septal defect and a large hyperplastic nodule in the liver. The patient was diagnosed with a Type II Abernethy malformation. We planned on surgical occlusion of the extrahepatic portocaval shunt. However, six months later, the patient had a sudden onset of a fever of unknown origin and developed hepatic encephalopathy. Although he underwent a liver transplantation, he died of acute hepatic failure.

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Clinical Features of Delirium in Liver Transplantation in a General Hospital in Korea-Retrospective Study (일병원에서 나타난 간이식 환자들의 섬망 양상-후향적 연구)

  • Choi, Soon-Ho;Son, Jung-In;Kim, Sang-Eok;Han, Oh-Su
    • Korean Journal of Psychosomatic Medicine
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    • v.15 no.2
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    • pp.93-99
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    • 2007
  • Object : This study aimed to investigate the characteristics of delirium in liver transplanted patients in a hospital in Korea. Method : We reviewed the medical records of 29 liver transplanted patients who were confirmed as delirium by psychiatrists with DSM-IV-TR diagnostic criteria. We estimated the correlation between delirium and clinical conditions of liver transplantations. Result : Post-operative delirium duration was significantly correlated with frequency of hepatic encephalopathy, pre-operative mental status, and stay of intensive care unit. Conclusion : Although there were many limitations of this study, it seemed that pre-operative hepatic encephalopathy affected post liver transplantation delirium.

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Etiologies, Prognostic Factors, and Outcomes of Pediatric Acute Liver Failure in Thailand

  • Getsuwan, Songpon;Lertudomphonwanit, Chatmanee;Tanpowpong, Pornthep;Thirapattaraphan, Chollasak;Tim-Aroon, Thipwimol;Wattanasirichaigoon, Duangrurdee;Treepongkaruna, Suporn
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.23 no.6
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    • pp.539-547
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    • 2020
  • Purpose: Pediatric acute liver failure (PALF) is a serious condition; however, data on PALF in developing countries are sparse, particularly concerning molecular diagnosis and liver transplantation (LT). This study aimed to determine the causes, outcomes, and prognostic factors of PALF. Methods: We retrospectively reviewed the medical records of children (age <15 years) with PALF diagnosed using the American Association for the Study of Liver Diseases criteria at our center from 2011 to 2016. The collected data included laboratory results, complications, outcomes, and potential factors associated with death and LT. Results: We included a total of 27 patients, with a median age of 2 years (interquartile range, 3 months to 4 years). Viral infection was the most common etiology (n=8, 30%), predominantly dengue infection (n=4). A total of 16 patients (59%) died and 11 patients survived (3 patients with LT). The prognostic factors associated with death or LT requirement were grade IV hepatic encephalopathy (p<0.01), hypotension (p=0.02), gastrointestinal bleeding (p=0.03), increased intracranial pressure (p=0.04), and higher peak serum lactate level (p=0.01). Peak serum lactate ≥6 mmoL/L had a sensitivity of 79% and a specificity of 88% for predicting mortality or the necessity of LT. Conclusion: Viral infection was the most common cause of PALF. The mortality rate remained high, and a considerable number of patients required LT. In addition to several clinical factors, peak serum lactate could be a potential marker for predicting poor outcomes in PALF.

Intrahepatic portosystemic shunt with a second degree atrioventricular block fixed by transvenous coil embolization in a dog

  • Lee, Seung-Gon;Nam, So-Jeong;Kim, Hyun-Wook;Hyun, Changbaig
    • Korean Journal of Veterinary Research
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    • v.48 no.4
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    • pp.493-500
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    • 2008
  • A 2-year-old female Pekingese dog was presented with primary complaints including exercise intolerance and neurological sign associated with hepatic encephalopathy. The major findings in clinical examination included an intermittent seizure, a slow heart rate with pulse deficit, leukocytosis and anemia in hemogram, elevated pre- and post-prandial serum bile acid and hepatic enzymes, hypoproteinemia, coagulopathy, ammonium urate crystaluria and bilirubinuria. Diagnostic tests revealed an intrahepatic portosystemic shunt complicated with a second degree atrioventricular block and QT prolongation. The case was successfully treated with a transvenous coil embolization. Clinical signs were gradually improved and cardiac bradyarrhythmia disappeared. This case is a rare case of intrahepatic portosystemic shunts complicated with a cardiac bradyarrhythmia in a small breed dog fixed by a transvenous coil embolization.

Liver Cirrhosis of Korean Native Goat in Korea : A Case Report (산양의 Liver cirrhosis 발생보고)

  • 민병만;박경애;김환균;조용성;김성열;구찬희;정운익;김홍집
    • Korean Journal of Veterinary Service
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    • v.16 no.1
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    • pp.57-64
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    • 1993
  • This survey was performed to report rare outbreak of liver cirrhosis in Korean native goat (KNG) which was died of Yangpyeong's goat farm on Feb. 1992. The examination for the KNG was carried out by clinical signs, necropsy and various lab-oratory test including parasitic, bacterial and histological test. The KNG looked jaundice, ascite, hemorrhage of lumen, abomasum and intestine, and brownish smooth cirrhotic liver at necropsy. Histological examination for liver revealed considerable proliferation of connective tissue and piecemeal necrosis which was caused by chronic active inflammation in interlobules and intralobules. There were atrophic micro and macro nodules which were sur-rounded by connective tissue. The lobular structure lack almost all central vein. The portal areas appearred proliferation of bile ducts, blood vessels and connective tissues. These connective tissue infiltrated heavily with plasma cells, Iymphocytes and histocytes. Histological examination for brain proved to be hepatic encephalopathy by virture of congestion and edema in cerebral medullary. From these results were demonstrated miked nodular, active, postnecrotic liver cirrhosis.

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An operation for the correction of Membranous obstruction of Inferior Vena Cava using Total Circulatory Arrest (전혈류 정지술을 이용한 하공정맥 폐색증의 교정수술)

  • Kim, Jhin-gook;Na, Myung-Hoon;An, Hyuk
    • Journal of Chest Surgery
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    • v.20 no.4
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    • pp.773-779
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    • 1987
  • MOVC is an uncommon disease which can be corrected by surgical method if early detected. A case of a 34-year-old male with MOVC is reported. Operation was done on cardiopulmonary bypass with circulatory arrest under moderate hypothermia. The incision was done both on the RA extending to level of suprahepatic IVC and on the IVC just proximal to the right renal vein. And then, thrombectomy and membranectomy under the direct visualization was done. Total circulatory arrest was used intermittently in order to get good visual field and for preventing blood loss. The Postop. course was good except one episode of hepatic encephalopathy which was persisted for 12 hours and then controlled by conservative measures.

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A Case of Hyperacute Liver Failure from Mushroom Intoxication in a Child Treated with Penicillin (페니실린으로 완치한 버섯 중독에 의한 소아 급성 간부전 1예)

  • Kwak, Byung-Ok;Bae, Sun-Hwan
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.2
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    • pp.210-213
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    • 2008
  • Hyperacute liver failure from mushroom intoxication in children is rare and has a low survival rate. We report a case of hyperacute liver failure from mushroom intoxication in a 29-month-old boy. The patient ingested a mushroom about three days prior to presentation. He was admitted to the hospital with vomiting, abdominal pain, seizures, and hematemesis. During the hospitalization the patient developed hepatic encephalopathy (stage IV-a), and a coagulopathy. He recovered fully with specific medication, Penicillin GK and N-acetylcysteine.

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Acquired Portosystemic Shunts Secondary to Hepatic Microvascular Dysplasia in a Young Dog

  • Hwang, Taesung;An, Soyon;Kim, Ahreum;Han, Changhee;Huh, Chan;Lee, Hee Chun
    • Journal of Veterinary Clinics
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    • v.37 no.2
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    • pp.88-90
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    • 2020
  • A one year old spayed female Bichon Frise dog presented with gait abnormalities and seizure. Serum biochemical results showed elevated levels of alkaline phosphatase, alanine aminotransferase, and ammonia. Serum bile acid level was also increased to be over 30 μmol/L on preprandial. Urinalysis identified the presence of ammonium urate crystal. Abdominal ultrasonography and CT revealed aberrant, tortuous, and multiple small vessels connected to the caudal vena cava between left kidney and caudal vena cava. Macroscopic specific findings associated with extrahepatic congenital portosystemic shunts (PSS) or other liver diseases were not identified. Liver biopsy was performed. Histopathologic evaluation revealed hepatic lobular hypoplasia with portal arterial duplication and vascular shunts. Based on these finding, this case was diagnosed as multiple acquired PSS secondary to hepatic microvascular dysplasia (HMD) and hepatic encephalopathy. A liver biopsy is recommended to differentiate HMD from other liver diseases and to confirm HMD when a young dog has multiple acquired PSS.

Effect of Dietary Protein on the Serum Xanthine Oxidase Activity in Methanethiol-treated Rats (식이성 단백질 함량이 Methanethiol 투여한 흰쥐의 혈청 Xanthine Oxidase 활성에 미치는 영향)

  • 윤종국;전태원;임영숙
    • Journal of Environmental Health Sciences
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    • v.19 no.1
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    • pp.66-70
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    • 1993
  • Introduction : Methanethiol is a toxicant that is a byproduct in the industrial process (oil refinery), and it is produced in vivo from methionine via transamination in case of its overintake. And it also can be generated by the action of mucosal thiol Smethyltransferase on hydrogen sulfite which is formed by anaerobic bacteria in the intestinal tract. The toxicity of methanethiol has often been suggested as one of endogenous factors involved in the pathogenesis of hepatic encephalopathy. Furthermore, methanethiol could cause the membrane damage and inhibition of some membrane protective enzymes.

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The Characteristics and Outcomes of Abernethy Syndrome in Korean Children: A Single Center Study

  • Kim, Eun Sil;Lee, Ki Wuk;Choe, Yon Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.22 no.1
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    • pp.80-85
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    • 2019
  • Purpose: Abernethy malformation is a rare condition, which was first described in 1793 as a congenital extrahepatic porto-systemic shunt (CEPS) directing splanchnic blood flow into the inferior vena cava. Eighty cases have been published so far that reported CEPS, while in Korea, very few cases have been reported. Through this study, we present 6 cases of patients diagnosed with CEPS at Samsung Medical Center and compare these with other such cases published in France and China. Methods: We reviewed clinical, laboratory, and imaging data of 6 children with CEPS in our pediatric clinic between 2004 and 2017. Results: A total of 6 children with CEPS was included in this study, namely, one with type 1a, two with type 1b, and three with type 2 CEPS. The most common presenting symptom was gastrointestinal bleeding (50.0%). Therapeutic interventions included shunting vessel ligation (16.7%) in type 2 CEPS and liver transplantation (16.7%) in type 2 CEPS patient with suddenly developed hepatic encephalopathy. Conclusion: There is no consensus guideline for the optimal management of patients with CEPS. Large-sample studies regarding CEPS are needed to evaluate the characteristics of patients with CEPS and determine the treatment guideline for CEPS.