Q:

Hepatic encephalopathy is a common systemic manifestation of chronic liver disease. Which of the following statement(s) is/are true concerning this condition?

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Hepatic encephalopathy is a common systemic manifestation of chronic liver disease. Which of the following statement(s) is/are true concerning this condition?


  1. Blood ammonia levels correlate well with the stage of hepatic encephalopathy
  2. Alterations in central nervous system neurotransmitters such as the neurotransmitter g- aminobutyric acid (GABA) have been proposed in the pathogenesis of hepatic encephalopathy
  3. Lactulose can be used to decrease intestinal ammonia absorption
  4. Patients can be expected to have an increased sensitivity to benzodiazepines

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b.Alterations in central nervous system neurotransmitters such as the neurotransmitter g- aminobutyric acid (GABA) have been proposed in the pathogenesis of hepatic encephalopathy

c.Lactulose can be used to decrease intestinal ammonia absorption

d.Patients can be expected to have an increased sensitivity to benzodiazepines

Hepatic encephalopathy, a poorly explained neuropsychiatric syndrome, characterized by diverse neurologic abnormalities, is the pathologic evidence of nonspecific structural changes in neurons, and a variable prognosis. Several hypotheses to explain the pathogenesis of hepatic encephalopathy have been proposed. Ammonia has been widely implicated in the pathogenesis of hepatic encephalopathy despite conflicting evidence. Blood ammonia levels correlate poorly with the stage of encephalopathy, however, one of the mainstays of treatment is measures to decrease ammonia absorption from the gut including the oral administration of lactulose. Another hypothesis has implicated false neurotransmitters in the pathogenesis of hepatic encephalopathy. Evidence suggests that activation of the GABA system may be important in the pathogenesis of hepatic encephalopathy. The GABA receptor binds several classes of ligands including GABA and drugs such as benzodiazepines. For reasons that are unclear, hepatic failure appears to increase the brain density of GABA receptors. This observation may explain the increased sensitivity to benzodiazepines and other inhibitory neurotransmitters observed with patients with chronic liver disease.

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