[Therapy of hepatic encephalopathy].

Abstract

The pathogenesis of the hepatic encephalopathy (HE) in spite of substantial progresses in this field still rests unclear. Actually four main hypotheses of the pathogenesis are discussed: the ammonia-hypothesis, the synergism-hypothesis, the hypothesis of the false neurotransmitters and that one of the changes of the normal neurotransmitters and their receptors. A connecting function seems to come up to ammonia. --Reduction of oral protein intake, selection of certain proteins, oral administration of nonabsorbable antibiotics and enemas should be used in order to prevent the intestinal absorption of toxic metabolic products. The parenteral nutrition has the therapy of HE substantially improved. Primarily, the patients receive special amino acid mixtures with a high content of branched chain amino acids and a low content of aromatic acids. The exchange of carbohydrate to some extent through fat improves the parenteral nutrition regime for these patients. The different liver support systems have failed to improve the prognosis of fulminant hepatic failure.