CLINICAL PRESENTATION A 72-year-old female with a history of autoinmune hepatitis-related cirrhosis, osteoporosis, and hypertension was admitted with recurrent episodes of confusion and drowsiness over the course of two years. On each occasion, the patient demonstrated fluctuating confusion with drowsiness and was disorientated to time and place. A marked liver flap was present on examination with no other features of hepatic decompensation. These episodes were associated with raised serum ammonia levels, normalneuroimaging findings and no features to suggest a precipitating illness. They became more frequent, severe and longer in duration in early 2014, promptingthree hospital admissions in 2 months despite being on optimal medical therapy of rifaximin, twicedaily enemas and maximally tolerated lactulose.
2014-08-28 | 250 visitas | Evalua este artículo 0 valoraciones
Vol. 13 Núm.5. Septiembre-Octubre 2014 Pags. 555-557 Ann Hepatol 2014; 13(5)