Recent Trends in Management of syndromes Related to Liver Cell Failure

Abstract

The liver is one of the body's most "intelligent" organs in that it performs so many different functions at the same time. This remarkable organ also has the ability to regenerate itself if it is injured or partially removed. The liver plays a central role in homeostasis including glycogen synthesis and storage, gluconeogenesis, protein and lipid metabolism, production of bile,plasma protein synthesis and drug detoxification. Thus the liver diseases leads to many deleterious effects on multiple organ systems, including the pulmonary system, cardiovascular system, renal functions and central nervous system. Hepatic encephalopathyis a term used to describe a broad range of neurologic and neuropsychiatric impairments seen in patients with significant underlying liver disease.During the course of the disorder, patients develop altered mental status with disorientation, inappropriate behavior, memory impairment, shortened attention span, slurred speech, confusion and eventually coma. An important prerequisite for the syndrome is diversion of portal blood into the systemic circulation through portosystemic collateral vessels.There is an agreed principle that the cause of hepatic encephalopathyis primarily due to gut-derived toxins. Ammonia appears to be the key toxin involved in the syndromeand a definitive connection between increased brain ammonia entry and cerebral edema has been established.