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==Overview==
==Overview==
Hepatic encephalopathy is caused by disorders that affect the liver. These include disorders that reduce liver function (such as [[cirrhosis]] or [[hepatitis]]) and conditions in which [[blood]] circulation does not enter the liver. The exact cause of hepatic encephalopathy is unknown.
The most common cause of hepatic encephalopathy is [[hepatic cirrhosis]], drugs/toxins and [[Fulminant hepatitis|acute fulminant hepatitis]]. Less common causes of hepatic encephalopathy include [[Wilson's disease]], [[Alpha 1-antitrypsin deficiency|alpha-1-antitripsin deficiency]], [[autoimmune hepatitis]], [[Budd-Chiari syndrome|Budd-chiari syndrome]], [[cancer]] or [[metastasis]] to [[liver]]), [[HELLP syndrome]]([[hemolysis]], elevated [[liver function tests]], and low [[Platelet|platelets]]) and [[sepsis]].


==Causes==
==Causes==
An important job of the liver is to change toxic substances that are either made by the body or taken into the body (such as medicines) and make them harmless. However, when the liver is damaged, these "poisons" may build up in the bloodstream.


Ammonia, which is produced by the body when proteins are digested, is one of the harmful substances that is normally made harmless by the liver. Many other substances may also build up in the body if the liver is not working well. They can cause damage to the nervous system.
=== Common causes ===
Common causes of hepatic encephalopathy include:<ref name="pmid18328931">{{cite journal| author=Schuppan D, Afdhal NH| title=Liver cirrhosis. | journal=Lancet | year= 2008 | volume= 371 | issue= 9615 | pages= 838-51 | pmid=18328931 | doi=10.1016/S0140-6736(08)60383-9 | pmc=2271178 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18328931  }} </ref>
* [[Hepatic cirrhosis]]
* Drugs and toxins ([[acetaminophen]]<ref name="pmid21705899">{{cite journal| author=Brusilow SW, Cooper AJ| title=Encephalopathy in acute liver failure resulting from acetaminophen intoxication: new observations with potential therapy. | journal=Crit Care Med | year= 2011 | volume= 39 | issue= 11 | pages= 2550-3 | pmid=21705899 | doi=10.1097/CCM.0b013e31822572fd | pmc=3196740 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21705899  }} </ref>, [[Amoxicilina|amoxicilin]]/[[Clavulanic acid|clavulanate]]<ref name="AndradeTulkens2011">{{cite journal|last1=Andrade|first1=R. J.|last2=Tulkens|first2=P. M.|title=Hepatic safety of antibiotics used in primary care|journal=Journal of Antimicrobial Chemotherapy|volume=66|issue=7|year=2011|pages=1431–1446|issn=0305-7453|doi=10.1093/jac/dkr159}}</ref>, [[halothane]]<ref name="pmid22087107">{{cite journal| author=Habibollahi P, Mahboobi N, Esmaeili S, Safari S, Dabbagh A, Alavian SM| title=Halothane-induced hepatitis: A forgotten issue in developing countries: Halothane-induced hepatitis. | journal=Hepat Mon | year= 2011 | volume= 11 | issue= 1 | pages= 3-6 | pmid=22087107 | doi= | pmc=3206652 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22087107  }} </ref>, [[iron]]<ref name="pmid18333235">{{cite journal| author=Castaldo ET, Chari RS| title=Liver transplantation for acute hepatic failure. | journal=HPB (Oxford) | year= 2006 | volume= 8 | issue= 1 | pages= 29-34 | pmid=18333235 | doi=10.1080/13651820500465741 | pmc=2131363 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18333235  }} </ref>, [[isoniazid]]<ref name="pmid20859496">{{cite journal| author=Khan FY, Rasoul F| title=Rifampicin-isoniazid induced fatal fulminant hepatitis during treatment of latent tuberculosis: A case report and literature review. | journal=Indian J Crit Care Med | year= 2010 | volume= 14 | issue= 2 | pages= 97-100 | pmid=20859496 | doi=10.4103/0972-5229.68226 | pmc=2936741 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20859496  }} </ref> ,[[carbon tetrachloride]]<ref name="pmid22489170">{{cite journal| author=Chang HM, Liao YW, Chiang CH, Chen YJ, Lai YH, Chang YL et al.| title=Improvement of carbon tetrachloride-induced acute hepatic failure by transplantation of induced pluripotent stem cells without reprogramming factor c-Myc. | journal=Int J Mol Sci | year= 2012 | volume= 13 | issue= 3 | pages= 3598-617 | pmid=22489170 | doi=10.3390/ijms13033598 | pmc=3317730 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22489170  }} </ref>, Wild mushroom [[Amanita phalloides]]<ref name="pmid22811920">{{cite journal| author=Santi L, Maggioli C, Mastroroberto M, Tufoni M, Napoli L, Caraceni P| title=Acute Liver Failure Caused by Amanita phalloides Poisoning. | journal=Int J Hepatol | year= 2012 | volume= 2012 | issue=  | pages= 487480 | pmid=22811920 | doi=10.1155/2012/487480 | pmc=3395149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22811920  }} </ref>)
* Acute [[fulminant]] [[viral hepatitis]]<ref name="pmid27413724">{{cite journal| author=Manka P, Verheyen J, Gerken G, Canbay A| title=Liver Failure due to Acute Viral Hepatitis (A-E). | journal=Visc Med | year= 2016 | volume= 32 | issue= 2 | pages= 80-5 | pmid=27413724 | doi=10.1159/000444915 | pmc=4926881 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27413724  }} </ref>


Hepatic encephalopathy may occur suddenly in people who previously had no liver problems when damage occurs to the liver. More often, the condition is seen in people with chronic liver disease.
===Less common causes===
Hepatic encephalopathy may be triggered by:
Less common causes of hepatic encephalopathy include:
*[[Wilson's disease|Wilson’s disease]]<ref name="pmid26041965">{{cite journal| author=Ferenci P, Litwin T, Seniow J, Czlonkowska A| title=Encephalopathy in Wilson disease: copper toxicity or liver failure? | journal=J Clin Exp Hepatol | year= 2015 | volume= 5 | issue= Suppl 1 | pages= S88-95 | pmid=26041965 | doi=10.1016/j.jceh.2014.09.002 | pmc=4442862 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26041965  }} </ref>
*[[Alpha 1-antitrypsin deficiency|Alpha-1-antitripsin deficiency]]<ref name="pmid22761482">{{cite journal| author=Brode SK, Ling SC, Chapman KR| title=Alpha-1 antitrypsin deficiency: a commonly overlooked cause of lung disease. | journal=CMAJ | year= 2012 | volume= 184 | issue= 12 | pages= 1365-71 | pmid=22761482 | doi=10.1503/cmaj.111749 | pmc=3447047 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22761482  }} </ref>
*[[Autoimmune hepatitis]]<ref name="pmid25923939">{{cite journal| author=Mendizabal M, Marciano S, Videla MG, Anders M, Zerega A, Balderramo DC et al.| title=Fulminant presentation of autoimmune hepatitis: clinical features and early predictors of corticosteroid treatment failure. | journal=Eur J Gastroenterol Hepatol | year= 2015 | volume= 27 | issue= 6 | pages= 644-8 | pmid=25923939 | doi=10.1097/MEG.0000000000000353 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25923939  }} </ref>
*[[Budd-Chiari syndrome|Budd-chiari syndrome]]<ref name="pmid26668741">{{cite journal| author=Martens P, Nevens F| title=Budd-Chiari syndrome. | journal=United European Gastroenterol J | year= 2015 | volume= 3 | issue= 6 | pages= 489-500 | pmid=26668741 | doi=10.1177/2050640615582293 | pmc=4669515 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26668741  }} </ref>
*[[Cancer]] ([[Primary liver cell carcinoma|primary hepatic cancer]] or [[metastasis]] to [[liver]])<ref name="pmid23505573">{{cite journal| author=Willson KJ, Nott LM, Broadbridge VT, Price T| title=Hepatic encephalopathy associated with cancer or anticancer therapy. | journal=Gastrointest Cancer Res | year= 2013 | volume= 6 | issue= 1 | pages= 11-6 | pmid=23505573 | doi= | pmc=3597933 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23505573  }} </ref>
*[[HELLP syndrome]] ([[hemolysis]], elevated [[liver function tests]], and low [[Platelet|platelets]])<ref name="pmid25838585">{{cite journal| author=Pandey CK, Karna ST, Pandey VK, Tandon M| title=Acute liver failure in pregnancy: Challenges and management. | journal=Indian J Anaesth | year= 2015 | volume= 59 | issue= 3 | pages= 144-9 | pmid=25838585 | doi=10.4103/0019-5049.153035 | pmc=4378074 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25838585  }} </ref>
*[[Sepsis]]<ref name="pmid23905041">{{cite journal| author=Cotena S, Piazza O| title=Sepsis-associated encephalopathy. | journal=Transl Med UniSa | year= 2012 | volume= 2 | issue=  | pages= 20-7 | pmid=23905041 | doi= | pmc=3728775 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23905041  }} </ref>
*[[Right heart failure]]<ref name="pmid20149988">{{cite journal| author=Saner FH, Heuer M, Meyer M, Canbay A, Sotiropoulos GC, Radtke A et al.| title=When the heart kills the liver: acute liver failure in congestive heart failure. | journal=Eur J Med Res | year= 2009 | volume= 14 | issue=  | pages= 541-6 | pmid=20149988 | doi= | pmc=3351940 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20149988  }} </ref>


*[[Dehydration]]
===Causes by Organ System===
*Eating too much [[protein]]
 
*Electrolyte abnormalities (especially a decrease in potassium) from vomiting, or from treatments such as [[paracentesis]] or taking [[diuretics]] ("water pills")
{| style="width:80%; height:100px" border="1"
*Bleeding from the intestines, stomach, or esophagus
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
*Infections
| style="width:75%" bgcolor="Beige" ; border="1" |[[Budd-Chiari syndrome|Budd-chiari syndrome]]
*Kidney problems
 
*Low oxygen levels in the body
[[Right heart failure]]
*Shunt placement or complications ([[Transjugular intrahepatic portosystemic shunt]])
|-
*Surgery
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
*Use of medications that suppress the central nervous system (such as [[barbiturates]] or [[benzodiazepine]] tranquilizers)
| bgcolor="Beige" | Drug and [[toxin]]<nowiki/>s([[acetaminophen]], [[Amoxicilina|amoxicilin]]/[[Clavulanic acid|clavulanate]], [[halothane]], [[iron]], [[NSAIDs]], [[isoniazid]] ,[[carbon tetrachloride]], Wild mushroom [[Amanita phalloides]])
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastrohepatic'''
| bgcolor="Beige" | [[Hepatic cirrhosis]], acute [[fulminant]] [[viral hepatitis]], [[Wilson's disease]], [[hemochromatosis]], [[Alpha 1-antitrypsin deficiency|alpha-1-antitripsin deficiency]], [[autoimmune hepatitis]], [[cancer]] (primary hepatic cancer or [[metastasis]] to liver)
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | [[Porphyria]], [[HELLP syndrome]] ([[hemolysis]], elevated [[liver function tests]], and low [[Platelet|platelets]])
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" |[[Sepsis]]
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | No underlying causes
|-
|}
 
===Causes in Alphabetical Order===
List the causes of the disease in alphabetical order.
{{columns-list|
* Cause 1:Acute [[fulminant]] [[viral hepatitis]]
* Cause 2:[[Alpha 1-antitrypsin deficiency|Alpha-1-antitripsin deficiency]]
* Cause 3:[[Autoimmune hepatitis]]
* Cause 4:[[Budd-chiari syndrome]]
* Cause 5:[[Cancer]]
* Cause 6:Drug and [[toxins]]
* Cause 7:[[HELLP syndrome]]
* Cause 8:[[Hepatic cirrhosis]]
* Cause 9:[[Sepsis]]
* Cause 10:[[Wilson's disease]]
}}


==References==
==References==
{{reflist|2}}


{{Reflist|2}}
[[Category:Disease]]
[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]

Latest revision as of 21:14, 10 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ;Mohamadmostafa Jahansouz M.D.[2]

Overview

The most common cause of hepatic encephalopathy is hepatic cirrhosis, drugs/toxins and acute fulminant hepatitis. Less common causes of hepatic encephalopathy include Wilson's disease, alpha-1-antitripsin deficiency, autoimmune hepatitis, Budd-chiari syndrome, cancer or metastasis to liver), HELLP syndrome(hemolysis, elevated liver function tests, and low platelets) and sepsis.

Causes

Common causes

Common causes of hepatic encephalopathy include:[1]

Less common causes

Less common causes of hepatic encephalopathy include:

Causes by Organ System

Cardiovascular Budd-chiari syndrome

Right heart failure

Chemical/Poisoning Drug and toxins(acetaminophen, amoxicilin/clavulanate, halothane, iron, NSAIDs, isoniazid ,carbon tetrachloride, Wild mushroom Amanita phalloides)
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastrohepatic Hepatic cirrhosis, acute fulminant viral hepatitis, Wilson's disease, hemochromatosis, alpha-1-antitripsin deficiency, autoimmune hepatitis, cancer (primary hepatic cancer or metastasis to liver)
Genetic No underlying causes
Hematologic Porphyria, HELLP syndrome (hemolysis, elevated liver function tests, and low platelets)
Iatrogenic No underlying causes
Infectious Disease Sepsis
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

List the causes of the disease in alphabetical order.

References

  1. ↑ Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
  2. ↑ Brusilow SW, Cooper AJ (2011). "Encephalopathy in acute liver failure resulting from acetaminophen intoxication: new observations with potential therapy". Crit Care Med. 39 (11): 2550–3. doi:10.1097/CCM.0b013e31822572fd. PMC 3196740. PMID 21705899.
  3. ↑ Andrade, R. J.; Tulkens, P. M. (2011). "Hepatic safety of antibiotics used in primary care". Journal of Antimicrobial Chemotherapy. 66 (7): 1431–1446. doi:10.1093/jac/dkr159. ISSN 0305-7453.
  4. ↑ Habibollahi P, Mahboobi N, Esmaeili S, Safari S, Dabbagh A, Alavian SM (2011). "Halothane-induced hepatitis: A forgotten issue in developing countries: Halothane-induced hepatitis". Hepat Mon. 11 (1): 3–6. PMC 3206652. PMID 22087107.
  5. ↑ Castaldo ET, Chari RS (2006). "Liver transplantation for acute hepatic failure". HPB (Oxford). 8 (1): 29–34. doi:10.1080/13651820500465741. PMC 2131363. PMID 18333235.
  6. ↑ Khan FY, Rasoul F (2010). "Rifampicin-isoniazid induced fatal fulminant hepatitis during treatment of latent tuberculosis: A case report and literature review". Indian J Crit Care Med. 14 (2): 97–100. doi:10.4103/0972-5229.68226. PMC 2936741. PMID 20859496.
  7. ↑ Chang HM, Liao YW, Chiang CH, Chen YJ, Lai YH, Chang YL; et al. (2012). "Improvement of carbon tetrachloride-induced acute hepatic failure by transplantation of induced pluripotent stem cells without reprogramming factor c-Myc". Int J Mol Sci. 13 (3): 3598–617. doi:10.3390/ijms13033598. PMC 3317730. PMID 22489170.
  8. ↑ Santi L, Maggioli C, Mastroroberto M, Tufoni M, Napoli L, Caraceni P (2012). "Acute Liver Failure Caused by Amanita phalloides Poisoning". Int J Hepatol. 2012: 487480. doi:10.1155/2012/487480. PMC 3395149. PMID 22811920.
  9. ↑ Manka P, Verheyen J, Gerken G, Canbay A (2016). "Liver Failure due to Acute Viral Hepatitis (A-E)". Visc Med. 32 (2): 80–5. doi:10.1159/000444915. PMC 4926881. PMID 27413724.
  10. ↑ Ferenci P, Litwin T, Seniow J, Czlonkowska A (2015). "Encephalopathy in Wilson disease: copper toxicity or liver failure?". J Clin Exp Hepatol. 5 (Suppl 1): S88–95. doi:10.1016/j.jceh.2014.09.002. PMC 4442862. PMID 26041965.
  11. ↑ Brode SK, Ling SC, Chapman KR (2012). "Alpha-1 antitrypsin deficiency: a commonly overlooked cause of lung disease". CMAJ. 184 (12): 1365–71. doi:10.1503/cmaj.111749. PMC 3447047. PMID 22761482.
  12. ↑ Mendizabal M, Marciano S, Videla MG, Anders M, Zerega A, Balderramo DC; et al. (2015). "Fulminant presentation of autoimmune hepatitis: clinical features and early predictors of corticosteroid treatment failure". Eur J Gastroenterol Hepatol. 27 (6): 644–8. doi:10.1097/MEG.0000000000000353. PMID 25923939.
  13. ↑ Martens P, Nevens F (2015). "Budd-Chiari syndrome". United European Gastroenterol J. 3 (6): 489–500. doi:10.1177/2050640615582293. PMC 4669515. PMID 26668741.
  14. ↑ Willson KJ, Nott LM, Broadbridge VT, Price T (2013). "Hepatic encephalopathy associated with cancer or anticancer therapy". Gastrointest Cancer Res. 6 (1): 11–6. PMC 3597933. PMID 23505573.
  15. ↑ Pandey CK, Karna ST, Pandey VK, Tandon M (2015). "Acute liver failure in pregnancy: Challenges and management". Indian J Anaesth. 59 (3): 144–9. doi:10.4103/0019-5049.153035. PMC 4378074. PMID 25838585.
  16. ↑ Cotena S, Piazza O (2012). "Sepsis-associated encephalopathy". Transl Med UniSa. 2: 20–7. PMC 3728775. PMID 23905041.
  17. ↑ Saner FH, Heuer M, Meyer M, Canbay A, Sotiropoulos GC, Radtke A; et al. (2009). "When the heart kills the liver: acute liver failure in congestive heart failure". Eur J Med Res. 14: 541–6. PMC 3351940. PMID 20149988.

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