Portal-Systemic Encephalopathy: Influence of Shunt Surgery and Relations to Serum Amino Acids

Abstract

Fifty patients with liver cirrhosis, portal hypertension, and a history of bleeding oesophageal varices underwent IS different cognitive psychometric tests to evaluate the presence of subclinical portal-systemic encephalopathy. None of the patients were clinically encephalopathic. The patients were compared with 50 healthy control subjects. Twenty-three patients showed definite signs of encephalopathy in the psychometric tests, 17 were normal, and 10 were borderline cases. The most pronounced abnormalities were seen in tests reflecting logic inductive capacity, visual spatial performance, cognitive flexibility, perceptual speed, spatial perceptive ability, and psychomotor performance. Tests reflecting word memory were less affected. Serum liver function tests did not differ between patients with deranged and normal brain functions. The serum isoleucine concentration was, however, significantly lower in the encephalopathic patients. The psychometric test results did not differ between patients with alcoholic and nonalcoholic liver cirrhosis, and no change was noted 2 years after shunt surgery.

Key Words:

• Alcohol
• liver cirrhosis
• liver function tests
• portal hypertension
• portal-systemic encephalopathy
• portal-systemic shunt
• psychometric tests
• serum amino acids