Talk:Hepatic encephalopathy

message: What other causes of hepatic encephalopathy are there that are not due to liver disease? JFW | T@lk 17:44, 9 November 2005 (UTC)
replies: text: Uhh, not many - given that it's called hepatic encephalopathy. Right? JFW | T@lk 23:01, 31 March 2007 (UTC)
thread_title: Heading

message: shows how ammonia is "trapped" in the brain. JFW | T@lk 23:01, 31 March 2007 (UTC)
thread_title: Early studies

message: - the new CHESS score (0-9). JFW | T@lk 21:04, 6 June 2007 (UTC)
thread_title:  CHESS score 

message: APT article on cost-effectiveness. Discourages routine use of rifamixin & suggests reserving it for those who fail on lactulose. JFW | T@lk 22:27, 9 August 2007 (UTC)
thread_title:  Cost-effectiveness 

message: Herbs of chicory root and milk thistle.
Some very good information on this.
Having known someone who suffered from this may I suggest , Herbs of chicory root and milk thistle, that are well known to treat the liver.... ()
--Caesar J. B. Squitti  :  Son of Maryann Rosso and Arthur Natale Squitti 20:53, 5 March 2008 (UTC)
thread_title:  Herbs of chicory root and milk thistle. 

message: In the "treatment" section we need to mention a few Cochrane reviews. Most of them are negative. They're all in this list. It should be clear that Cash shrugs at the Cochrane lactulose review, and states that from experience the stuff works. I don't think we can avoid citing that, but it would be nice if there were other sources also nixing the review. JFW | T@lk 23:03, 21 February 2010 (UTC)
thread_title:  Cochrane 

message: Having just completed the "diagnosis" section, I thought I should do a little list of things to do:
*  Signs and symptoms - could theoretically have more about MHE
*  Classification - we could still mention Harry Conn's PSE score but this is a research tool and Ferenci and Cash state that it is no better than other tools
*  Pathogenesis - this will come mostly from Cash
*  Diagnosis
* Treatment - will come mostly from Cash; a lot of primary research needs to be trimmed; Cochrane reviews where appropriate
** Previous content on Hepatic encephalopathy/temp while I rewrite this section
**  Acute vs chronic
**  Diet
**  Lactulose/Lactitol
**  Antibiotics - will need to discuss neomycin, metronidazole and rifaximin
**  LOLA - from Cash and others
**  Combination therapy - touched on in the rifaximin and LOLA sections
** Unsure if we need to mention flumazenil and acarbose and all those other things that are not in widespread use. Cash and Sundaram discuss a number of others too. MARS really belongs in the acute liver failure article, as its use is simply a bridge to transplant.
*  Epidemiology/Prognosis - need to mention 70% prevalence of MHE or worse in cirrhotics; need to mention the fact that long-term prognosis is determined by the Child-(Turcotte)-Pugh (or MELD) rather than the severity of the HE - but you need to survive the HE first and furthermore proper HE will nudge up your CTP by a few points - need sources for that bit of wisdom
*  History - Weissenborn refers to Hippocrates (yes, who else) as well as studies from the Sheila Sherlock area that first attempted to quantify HE; sounds like a source of sorts
Any help appreciated, as always. JFW | T@lk 01:54, 22 February 2010 (UTC)
thread_title:  Time for a little list 

message: In all the reading I have not really come across a good historical overview of HE. I've had the temerity to email Prof Harold Conn, whose West Haven work is still relied upon, and am awaiting a reply. Otherwise there's some bits from Weissenborn as described.
I might list some interesting historical sources here, not suggesting that all are included.
*  - Sherlock's team, still at PGMS, introducing neomycin, then very expensive!
*  - listed above, using radiolabeled ammonia to demonstrate how it goes to the brain
JFW | T@lk 00:26, 23 February 2010 (UTC)
replies: text: Have also emailed a friendly hepatologist for further advice, but tried my best with the sources at hand. JFW | T@lk 12:23, 2 March 2010 (UTC)
thread_title: History

message: Bajaj in his 2010 APT review lists the Critical Flicker Frequency test and the Inhibitory Control Test. I decided not to mention them because the Randolph paper does not recommend them, and because Bajaj concedes that they still need validating. JFW | T@lk 09:58, 2 March 2010 (UTC)
thread_title:  Bajaj 

message: Only  was good enough to respond to the peer review, but I have incorporated most of his recommendations and am therefore submitting for GA. JFW | T@lk 21:50, 14 March 2010 (UTC)
thread_title:  GA while PR 

message: doi:10.1111/j.1365-2036.2011.04590.x - consensus statement on the design of clinical trials. This is hopeful. Perhaps we'll get some more hard data on the various treatments soon. JFW | T@lk 22:06, 1 October 2011 (UTC)
thread_title:  Trials 

message: Small trial, not for inclusion but interesting in case secondary sources appear: doi:10.1136/gutjnl-2012-303262 (PHE score comes out best). JFW | T@lk 20:39, 14 September 2013 (UTC)
thread_title:  Best test for MHE? 

message: Wijdicks doi:10.1056/NEJMra1600561 JFW | T@lk 08:10, 27 October 2016 (UTC)
thread_title:  NEJM review