Pathogenesis of hepatic coma
摘要
<h3>Definition and Classification</h3> SINCE the precise etiology of hepatic coma is unknown, any discussion of pathogenesis requires a definition and brief description of the clinical entity, a listing of the predisposing and precipitating factors, and a careful review of the biochemical and physiological alterations taking place.<sup>1</sup> Hepatic coma is a disorder of consciousness occurring in patients with severe liver disease; a neuropsychiatric disturbance with no striking anatomic basis. The manifestations may be extreme, yet are entirely reversible, and the brain does not show pathologic changes that will account for the symptoms.<sup>2</sup> Episodes of hepatic coma may be classified as<i>spontaneous</i>or<i>induced</i>, or alternatively as endogenous or exogenous in origin. The clinical manifestations of both types are similar, a fact that often makes their differentiation difficult. The spontaneous cases have no evident precipitating factor, being simply the final consequence of practically complete liver cell destruction. The induced cases