61. En : On Medical Dictionary Online Mercury encephalopathy, Metabolic encephalopathy, Metabolic, Acquired encephalopathy,Myoclonic encephalopathy, Portal Systemic encephalopathy, portalsystemic http://www.online-medical-dictionary.org/?q=~En

62. STI: Transjugular Intrahepatic Portal-Systemic Shunt Procedure The transjugular intrahepatic portalsystemic shunt, or TIPS, procedure is not asurgical operation a radiologist performs the procedure in encephalopathy. http://www.sti.upmc.edu/STI_Patient_web/sti/l-1c5.TIPS.asp

The Transjugular Intrahepatic Portal-Systemic Shunt (TIPS) Procedure The transjugular intrahepatic portal-systemic shunt, or TIPS, procedure is not a surgical operation a radiologist performs the procedure in the x-ray room under x-ray guidance. During the TIPS procedure, a radiologist places a stent (a tubular device) in the middle of the liver to reroute blood flow from the portal vein, which leads to the liver, directly into the hepatic veins and to the vena cava (the largest vein leading from the liver to the heart). The TIPS procedure reroutes blood flow around the liver and reduces pressure in all abnormal veins not only in the stomach and esophagus, but also in the bowel and liver. TIPS provides immediate control of variceal bleeding in more than 90 percent of patients. Needless to say, innumerable TIPS procedures have been performed successfully at the Thomas E. Starzl Transplantation Institute. The procedure lasts from 1 to 3 hours. Patients usually remain in the hospital for two to three days after the procedure. Before discharge, the physician orders a repeat Doppler sonogram to determine whether the shunt is functioning properly.

63. Portal Systemic Encephalopathy Other characters, Portal systemic encephalopathy,. Print this article, see bilirubinencephalopathy. FS. The Encyclopaedia of Medical Imaging Volume VI1. http://www.amershamhealth.com/medcyclopaedia/medical/Volume VI 1/PORTAL SYSTEMIC

Amershamhealth.com Search for: Type a word or a phrase. All forms of the word are searchable. Browse entry words starting with: A B C D ... Other characters Portal systemic encephalopathy, see bilirubin encephalopathy FS The Encyclopaedia of Medical Imaging Volume VI:1 Contacts GE Healthcare Making Waves

64. Portal Systemic Encephalopathy - General Practice Notebook portal systemic encephalopathy. Hepatic encephalopathy is a metabolicdisorder of the central nervous system and neuromuscular system http://www.gpnotebook.co.uk/cache/-1087045620.htm

portal systemic encephalopathy Hepatic encephalopathy is a metabolic disorder of the central nervous system and neuromuscular system that may complicate liver failure from any cause. It is particularly associated with advanced cirrhosis on account of the diffuse parenchymal damage and portosystemic shunting. The features depend on the aetiology and precipitating factors, eventually developing into stupor and then coma. Some aetiologies of the hepatic failure, for example paracetamol overdose, can precipitate this condition within three or four days, with a very rapid progression through the grades of encephalopathy. Other aetiologies, for example viral hepatitis, are associated with a much more variable onset. The grade of the encephalopathy can be used to predict the prognosis - for example grades I and II have and excellent prognosis, grades III and IV have poorer prognoses with the development of complications. Click here for more information...

65. Portal Systemic Encephalopathy - General Practice Notebook portal systemic encephalopathy. Medical search. Hepatic encephalopathy isa metabolic disorder of the central nervous system and neuromuscular http://www.gpnotebook.co.uk/medwebpage.cfm?ID=-1087045620

66. Entrez PubMed A new therapy for portal systemic encephalopathy. It is suggested that these medicationsmay be useful in the treatment of portal systemic encephalopathy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstra

67. Data Sheet Hepatic encephalopathy (Portal systemic encephalopathy, hepatic coma) is a neuropsychiatricsyndrome which can complicate all forms of hepatic disease. http://www.medsafe.govt.nz/Profs/Datasheet/a/Alphalactulosesyrup.htm

Data Sheet ALPHA-LACTULOSE Lactulose 3.34g/5mL Presentation Uses Actions Lactulose is a synthetic disaccharide used in the treatment of constipation and in hepatic encephalopathy. Studies in patients with a history of chronic constipation have shown that lactulose therapy causes a significant increase in the number of bowel movements per day and the number of days on which bowel movements occur. Lactulose reaches the colon virtually unchanged. There it is metabolised by colonic bacteria to lactic acid and other shortchain carboxylic acids. The end result is a change in the osmotic pressure and acidification of the colonic contents resulting in an increase in stool water content with resultant distention and softening of the stool which in turn promotes increased peristalsis and bowel evacuation. It may take 48 hours before an effect is obtained. The therapeutic action of lactulose in ameliorating the symptoms of hepatic encephalopathy is considered to be a result of the following: Reduction of faecal pH leading to a reduced ammonia absorption via nonionic diffusion and/or diffusion of ammonia from the blood into the gut. The trapped ammonia is then excreted in the stools. Suppression of urase producing organisms Induction of an osmotic type of diarrhoea which diminishes faecal statis with reduction of nitrogenous substances for ammonia production. Decreased absorption of ammonia from the gut also results from shortening intestinal transit time.

68. NIMULID TABLET Livoluk solution is a brand of Lactulose, a synthetic disaccharide, which ishighly useful in the management of portal systemic encephalopathy and also http://www.panacea-biotec.com/products/livoluk.htm

For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only LIVOLUK Description Pharmacology Pharmacokinetics Indications ... Dosage and Administration Description: Livoluk solution is a brand of Lactulose, a synthetic disaccharide, which is highly useful in the management of portal systemic encephalopathy and also constipation. LIVOLUK is colourless to amber, syrupy liquid. Each 15ml contains: Lactulose 10g (As Lactulose Concentration USP) Pharmacology: TOP Pharmacokinetics: Lactulose is poorly absorbed. When given orally, only small amounts reach the blood. Urinary excretion is less than or equal to 3% and is essen­tially complete within 24 hours. Lactulose exerts its effect only in the colon. Transit time through the colon may be slow, therefore, 24-48 hours may be required to produce a normal bowel movement. Indications: Livoluk is indicated in the treatment of constipation, chronic constipation, after haemorrhoidectomy, in elderly after barium meal examination, in bed ridden or institutionalized patients and others, in prevention and treatment of portal systemic encephalopathy including the stages of hepatic pre-coma and coma. Livoluk reduces blood ammonia levels by 25% to 50%. This generally parallels improved mental state and EEG patterns. Contraindications: Livoluk is contraindicated in patients who require a low galactose diet.

69. DUPHALAC Syrup In portal systemic encephalopathy administration of large doses of Duphalacresults in a significant reduction in the pH of the colonic contents. http://home.intekom.com/pharm/schering/duphalac.html

INDICATIONS CONTRA-INDICATIONS DOSAGE SIDE-EFFECTS PREGNANCY OVERDOSE IDENTIFICATION PATIENT INFORMATION DUPHALAC syrup SCHEDULING STATUS: Unscheduled PROPRIETARY NAME (and dosage form): DUPHALAC syrup COMPOSITION 5 mL Duphalac contains lactulose (4-0-b-D-galactopyranosyl-D-fructofuranose) 3,3 g. PHARMACOLOGICAL CLASSIFICATION A. 11.5 Laxatives. PHARMACOLOGICAL ACTION Duphalac is a synthetic disaccharide of fructose and galactose, which is not split into its monosaccharide constituents in the small intestine due to the lack of a specific enzyme. It reaches the colon unchanged where it is broken down by the saccharolytic flora into organic acids, such as lactic acid and acetic acid, acids formed in the colon under physiological conditions. Due to this local osmotic effect in the colon, water is retained, the faecal mass softened and normal colonic peristalsis restored. The mode of action differs from that of conventional laxatives. In portal systemic encephalopathy administration of large doses of Duphalac results in a significant reduction in the pH of the colonic contents. Lowering the pH promotes conversion of non-ionised ammonia into ionised form. The latter form being non-absorbable leads to reduction of absorption of ammonia from the intestine into the portal circulation and may even promote the excretion of ammonia from the circulation into the faeces. In addition, the enhanced growth of saccharolytic bacteria results in a decreased formation of ammonia.

70. LAXETTE SOLUTION In portal systemic encephalopathy administration of large doses of LAXETTEresults in a significant reduction in the pH of the colonic contents. http://home.intekom.com/pharm/cipla/laxette.html

INDICATIONS CONTRA-INDICATIONS DOSAGE SIDE-EFFECTS PREGNANCY OVERDOSE IDENTIFICATION PATIENT INFORMATION LAXETTE SOLUTION SCHEDULING STATUS: Not scheduled PROPRIETARY NAME (and dosage form): LAXETTE SOLUTION COMPOSITION: Each 5 mL LAXETTE contains 3,3 g lactulose PHARMACOLOGICAL CLASSIFICATION: A 11.5 Laxatives. PHARMACOLOGICAL ACTION: LAXETTE is a synthetic disaccharide of fructose and galactose, which is not split into its monosaccharide constituents in the small intestine due to the lack of a specific enzyme. It reaches the colon unchanged where it is broken down by the saccharolytic flora into organic acids, such as lactic acid and acetic acid - acids formed in the colon under physiological conditions. Due to this local osmotic effect in the colon, water is retained, the faecal mass softened and normal colonic peristalsis restored. In portal systemic encephalopathy administration of large doses of LAXETTE results in a significant reduction in the pH of the colonic contents. Lowering the pH promotes conversion of non-ionised ammonia into ionised form. The latter form being non-absorbable leads to reduction of absorption of ammonia from the intestine into the portal circulation and may even promote the excretion of ammonia from the circulation into the faeces. LAXETTE cannot be hydrolysed in the intestine, thus very little absorption occurs. Small amounts of non-hydrolysed lactulose may be absorbed, but these are readily excreted via the kidneys.

71. Liver Disorders Hemolytic. Portal Systemic encephalopathy. ©Neurological. ©4 stages;. TIPS.©Surgical shunts. Portal Systemic encephalopathy. ©Diet Therapy. ©Drug Therapy. http://cfcc.net/faculty/phoward/Hepatic Biliary 2.htm

Liver Disorders Paige Howard CFCC ADN Program Cirrhosis Chronic, progressive disease Types of Cirrhosis Laennec’s (alcoholic) Postnecrotic Biliary Cardiac Complications Portal Hypertension Ascites Bleeding esophageal varices Coagulation defects Jaundice Portal-systemic encephalopathy Hepato-renal syndrome Portal Hypertension Increased resistance or obstruction to the flow of blood through the portal vein Collateral circulation Ascites Accumulation of fluid (mainly plasma) in peritoneal cavity Chronic liver disease (cirrhosis)-most common cause Sodium and water excess Abdominal distension Bulging flanks, dull to percussion Protruding umbilicus Interventions Dietary Na+/fluid restriction Diuretics Bedrest, HOB elevated Daily weights Abdominal Paracentesis Colloid infusion Surgical Complications Vomiting esophagitis Dyspnea Transudation of fluid into the scrotum Pleural Anorexia Reflux effusion Peritoneal infection Bleeding Esophageal Varices Coagulation Defects Decrease in the synthesis of bile fats in the liver Prevents the absorption of fat-soluble vitamins (K) Absence of vit. K =insufficient clotting factors

72. Digestive Disease Library Portal systemic encephalopathy accompanies portal systemic shunting, arising asa result of portal hypertension or following TIPS or surgery targeted at http://www.hopkins-gi.org/pages/latin/templates/index.cfm?pg=disease3&organ=2&di

73. Karger Publishers External Resources 7 Conn HO, Leevy CM, Vlahovic ZR, et al Comparison of lactuloseand neomycin in the treatment of chronic portal systemic encephalopathy. http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ProduktNr=

74. Encephalopathy 6. encephalopathy hiv. 5. encephalopathy neonatal. 4. portal systemic encephalopathy.4. encephalopathy myalgic. 4. liver encephalopathy. 3. encephalopathy perinatal.3. http://www.websters-online-dictionary.org/definition/english/En/Encephalopathy.h

Philip M. Parker, INSEAD. Encephalopathy Definition: Encephalopathy Encephalopathy Noun . Any disorder or disease of the brain. Source: WordNet 1.7.1 Etymology: Websters 1913 Specialty Definitions: Encephalopathy Domain Definitions Health A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. ( references Source: compiled by the editor from various references ; see credits. Top Synonyms: Encephalopathy Synonyms: brain disease (n), brain disorder (n). ( additional references Top Crosswords: Encephalopathy English words defined with "encephalopathy" Wernicke's encephalopathy references Specialty definitions using "encephalopathy" Bovine spongiform encephalopathy boxer's encephalopathy Creutzfeldt-Jacob Disease Gerstmann-Str¤ussler-Scheinker syndrome ... Top Commercial Usage: Encephalopathy Domain Title Books Cerebral Energy Metabolism and Metabolic Encephalopathy reference Disorders of Mental Status: Dementia, Encephalopathy , Coma, Syncope ( reference Epilepsy, Infantile Spasms, and Developmental Encephalopathy reference Hypoxic-Ischemic Encephalopathy in the Newborn [DOWNLOAD: ADOBE READER] ( reference Mad Cow Disease: Bovine Spongiform Encephalopathy (Epidemics) ( reference (more book examples) Source: compiled by the editor from various references ; see credits.

75. Jaypharm Korea Monohydrate ). 5. Therapeutic Indications. (1) Constipation (2) Acuteand chronic Portal systemic encephalopathy. 6. Mode of action. Lactitol http://www.jaypharm.com/en_product_sub01.html

Lactitol is new Prebiotics developed by Purac, Netherlands. Lactitol is a soluble disaccharide derivative which is metabolized by the intestinal microflora producing organic acids, thus reducing the pH of the colon. Consequently, it is normalizing the physiological rhythm of the colon and effectively treats constipation. ctri-Lactitol powder 1. Trade name ctri-Lactitol powder 2. Qualitative and Quantitative composition: Lactitol monohydrate 20g / sachet. There are no other ingredients 3. Pharmaceutical Form White, crystalline powder 4. Chemical formula ( 4-¥â D-Galactopyranosyl-D-Sorbitol Monohydrate ) 5. Therapeutic Indications (1) Constipation (2) Acute and chronic Portal systemic encephalopathy 6. Mode of action Lactitol is a disaccharide derivative consisting of galactose and sorbitol which is only minimally absorbed and is not hydrolysed by the disaccharidases of the gastrointestinal tract and thus reaches the colon unchanged. In the colon it is broken down to short chain organic acids, mainly acetic

76. Children's Memorial Hospital (Chicago, IL) -- Liver Disorders removed by the liver. Liver encephalopathy is also called portalsystemicencephalopathy, hepatic encephalopathy, or hepatic coma. http://www.childrensmemorial.org/depts/gastroenterology/liver/default.asp

Home Medical Departments Digestive Disorders Liver Disorders Liver Disorders What are some common liver disease symptoms? What is jaundice? What is cholestasis? What is liver enlargement? ... What is portal hypertension? What are some common liver disease symptoms? When diagnosing liver disease, the physician looks at the patient's symptoms and conducts a physical examination. In addition, the physician may request a liver biopsy, liver enzyme tests, an ultrasound, or a CT scan (computed tomography scan). Some common liver disease symptoms include the following, each of which are described briefly below: jaundice, cholestasis, liver enlargement, portal hypertension , ascites, liver encephalopathy and liver failure. Return to top What is jaundice? Jaundice is a yellow discoloration of the skin and whites of the eyes due to an abnormally high level of bilirubin (bile pigment) in the bloodstream, which is then excreted through the kidneys. High levels of bilirubin may be attributed to inflammation or other abnormalities of the liver cells, or blockage of the bile ducts. Sometimes jaundice is caused by the breakdown of a large number of red blood cells, which can occur in newborns. Jaundice is usually the first sign, and sometimes the only sign, of liver disease. Return to top What is cholestasis?

77. Gammagard Settlement Notice - Definitions Of Qualifying Conditions (E) Portal Systemic encephalopathy. Portal Systemic encephalopathy( PSE ) is a brain syndrome due to liver disease. Proof of this http://www.ssem.com/gammagard/settlement/notice/attachmenta.html

CLICK HERE Return to Settlement Notice ATTACHMENT A DEFINITIONS OF QUALIFYING CONDITIONS Settlement class members should note that the following medical terms necessarily involve technical words. You should consult your doctor about these medical conditions. (A) Ascites. Ascites is an abdominal fluid collection within the peritoneal cavity. Proof of this condition shall require all of the following: an abdominal ultrasound or computerized tomography ("CT") scan of the abdomen to confirm that ascitic fluid is present; an abdominal paracentesis that removes at least 500 milliliters of ascitic fluid; and paracentesis fluid analysis with all of the following tests and all of the following results: TEST RESULT Cytology Negative for malignancy Polymorphonuclear (PMN) cell count Serum-ascites albumin gradient (SAAG) (defined as ascites albumin subtracted from serum albumin) Protein Bacterial culture at bedside in blood culture bottles, aerobic and anaerobic No growth Mycobacterial culture No growth Amylase Ascites amylase less than serum amylase The following conditions are possible "Alternative Causes" of Ascites in a patient with or without HCV: malignancy, primary or metastatic; protein-losing enteropathy; heart failure; ruptured viscus; tuberculosis; dengue, cholera or schistosomiasis; pancreatitis; kidney failure; chlamydia infection; fungal or parasitic infection in the peritoneum; peritonitis (other than spontaneous bacterial peritonitis); Budd Chiari syndrome; portal vein thrombosis or occlusion (intra or extra luminal); use of amiodarone; exposure to or ingestion of hepatotoxin; or consumption of significant amounts of alcohol (consumption of enough alcohol for a sufficient period of time to produce, either separately or in a synergistic fashion with HCV, the progression of liver damage).

78. IM Abstract 39-5 Case Reports 10 Portal Systemic encephalopathy Presenting with Dressing and ConstructionalApraxia. We report a case with portal systemic encephalopathy http://www.naika.or.jp/im/im39/ab3905/c390510.html

Home Table of Issues Vol.39 No.5 Portal Systemic Encephalopathy Presenting with Dressing and Constructional Apraxia We report a case with portal systemic encephalopathy who presented with dressing and constructional apraxia and subtle weakness of the left hand. We initially suspected a cerebrovascular attack in the right cerebral hemisphere, but brain T1-weighted magnetic resonance (MR) imaging revealed high intensity in the basal ganglia and hyperammonemia was detected. We performed abdominal MR angiography, which visualized an intrahepatic portal systemic shunt. Cerebral blood flow, measured by xenon-enhanced computed tomography, was decreased in the bilateral, but more dominantly right-sided, parietal watershed regions. We speculate that these boundary territories might be susceptible to damage by toxic metabolites of hepatic encephalopathy. (Internal Medicine 39: 419-423, 2000) Takeshi Kanda, Shigeru Nogawa, Kazuhiro Muramatsu, Atsuo Koto and Yasuo Fukuuchi From the Department of Neurology, Keio University, Tokyo Received for publication June 29, 1999; Accepted for publication November 1, 1999 Home Table of Issues Vol.39 No.5

79. IM Abstract 40-9 Case Reports 2 extrahepatic portosystemic venous shunt in a 37year-old woman without liver cirrhosisor portal hypertension, who developed portal systemic encephalopathy. http://www.naika.or.jp/im/im40/ab4009/c400902.html

Home Table of Issues Vol.40 No.9 An Inferior Mesenteric-Caval Shunt via the Internal Iliac Vein with Portosystemic Encephalopathy We report here a case of an unusual extrahepatic portosystemic venous shunt in a 37-year-old woman without liver cirrhosis or portal hypertension, who developed portal systemic encephalopathy. Angiography demonstrated an inferior mesenteric-caval shunt characterized by the presence of direct communication of the inferior mesenteric vein with the left internal iliac vein. After the treatment with percutaneous transcatheter embolization of the shunt via a femoral vein approach using coils, she had no episode of portal systemic encephalopathy. Mamiko Otake, Yoshimasa Kobayashi, Dai Hashimoto, Tatsuya Igarashi*, Motoichirou Takahashi*, Hiroko Kumaoka, Masahiro Takagi, Kinya Kawamura, Shigeki Koide, Yuzo Sasada, Fujito Kageyama, Tsunehisa Kawasaki and Hirotoshi Nakamura From the Second Department of Internal Medicine and *the Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu Home Table of Issues Vol.40 No.9

80. HEPATIC ENCEPHALOPATHY HEPATIC encephalopathy. PORTAL SYSTEMIC encephalopathy (PSE). BackgroundPSE is defined as a change in mentation in a patient with http://www.columbia.edu/~jj2085/residency/fulltext/HEPATICXENCEPHALOPATHYX3.html

HEPATIC ENCEPHALOPATHY PORTAL SYSTEMIC ENCEPHALOPATHY (PSE) Background: PSE is defined as a change in mentation in a patient with cirrhosis and portal hypertension Cause of PSE remains contentious (? Ammonia, GABA, Mercaptans) CNS lesion is Astrocyte hyperplasia (Alzheimer type II astrocyte change) Stages of Hepatic Encephalopathy STAGE MENTAL STATUS PHYSICAL EXAM I Euphoria/Depression, Day-Night Sleep reversal, Mild asterixis (may be absent) poor concentration, mild confusion, slurred speech II Increased drowsiness, confusion, inability to sustain Significant Asterixis, Concentration Brisk reflexes III Marked confusion, arousable but sleeping continuously Asterixis, clonus Asterixis absent Risk factors: High protein load (i.e. GI bleeding, increase in protein intake) SBP Infection Constipation Hypokalemia Narcotics, Benzodiazepines Liver failure Post TIPS Portal vein thrombosis Treatment: Cure constipation (enema, Mg Citrate, MOM) Consider Branched chain amino acid nutritional supplements (Hepatic Aid/Nutrahep/Hepatamine) Lactulose 30 cc po every 1-2 hrs until soft bowel movement, titrate to achieve 2-3 soft bowel movements a day

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