Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

680 Hepatic Encephalopathy Hepatic Veno-Occlusive Disease

■titrate medications according to therapeutic response and side

effects of the medications

Routine

■lactulose titrated to 2–3 loose bowel movements per day

■alternative or additional therapy may include

➣neomycin q.i.d. orally

➣vegetable-based protein diet

■therapeutic options for refractory HE

➣TIPS shunt reduction or obliteration

➣liver transplantation

complications and prognosis

■60–85% 1-year survival with refractory hepatic encephalopathy

Hepatic Veno-occlusive Disease.........................

MINDIE H. NGUYEN

history & physical

History

■acute form: following bone marrow transplantation (BMT) with

high-dose cytoreductive chemotherapy with or without hepatic irra-

diation

Risk Factors:

■pretransplant fever or elevation of AST or ALT

■fever before cytoreductive therapy not responsive to broad-

spectrum antibiotics or fever occurring after cytoreductive therapy

■history of abdominal radiation, history of viral or drug-induced hep-

atitis

■radiation dose >12 Gy

■cytoreductive regimens of cyclophosphamide plus busulfan, or

cyclophosphamide plus BCNU and etoposide

■chronic form: secondary to toxicity of pyrrolizidine alkaloids from

plants of the Crotalatia, Senecio, Heliotropium genera found in

herbal teas ( Jamaican bush tea disease)

Signs & Symptoms

■2 or more of the following criteria within 20 days after BMT (Seattle

criteria):

■painful hepatomegaly