Hepatic encephalopathy for the hospitalist
Autor: | Joseph R. Sweigart, Bruce Bradley, Alla Grigorian |
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Rok vydání: | 2016 |
Předmět: |
Liver Cirrhosis
medicine.medical_specialty Pediatrics Leadership and Management medicine.medical_treatment Population MEDLINE Assessment and Diagnosis Rifaximin 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Anti-Infective Agents Ambulatory care medicine Humans 030212 general & internal medicine education Intensive care medicine Care Planning Hepatic encephalopathy Subclinical infection education.field_of_study business.industry Health Policy General Medicine medicine.disease Rifamycins Hospital medicine chemistry Hospitalists Hepatic Encephalopathy 030211 gastroenterology & hepatology Fundamentals and skills Portasystemic Shunt Transjugular Intrahepatic business Transjugular intrahepatic portosystemic shunt |
Zdroj: | Journal of Hospital Medicine. 11:591-594 |
ISSN: | 1553-5606 1553-5592 |
Popis: | The care of patients with advanced liver disease is often complicated by episodes of acute decline in alertness and cognition, termed hepatic encephalopathy (HE). Hospitalists must be familiar with HE, as it is a common reason for hospitalization in this population and is associated with significantly increased mortality. This narrative review addresses common issues related to diagnosis and classification, precipitants, inpatient management, and transitions of care for patients with HE. The initial presentation can be variable, and HE remains a clinical diagnosis. The spectrum of HE manifestations spans from mild, subclinical cognitive deficits to overt coma. The West Haven scoring system is the most widely used classification system for HE. Various metabolic insults may precipitate HE, and providers must specifically seek to rule out infection and bleeding in cirrhotic patients presenting with altered cognition. This is consistent with the 4-pronged approach of the American Association for the Study of Liver Disease practice guidelines. Patients with HE are typically treated primarily with nonabsorbable disaccharide laxatives, often with adjunctive rifaximin. The evidence for these agents is discussed, and available support for other treatment options is presented. Management issues relevant to general hospitalists include those related to acute pain management, decisional capacity, and HE following transjugular intrahepatic portosystemic shunt placement. These issues are examined individually. Successfully transitioning patients recovering from HE to outpatient care requires open communication with multiple role players including patients, caregivers, and outpatient providers. Journal of Hospital Medicine 2016;11:591-594. © 2016 Society of Hospital Medicine. |
Databáze: | OpenAIRE |
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