HEPATIC-ENCEPHALOPATHY FOLLOWING PORTO-SY STEMIC SHUNT

A total of 28 cirrhotic patients with portosystemic anastomosis were c ompared with 38 cirrhotic patients without porto-systemic shunts conce rning their mental state and biochemical parameters of importance for hepatic encephalopathy. A group of 37 metabolically healthy individual s provided the reference values for the psychometric test results and the EEG power spectra. Laboratory values for both groups showed margin al elevation of bilirubin, while the ammonia levels were significantly increased in the operated group. A significant difference was found c oncerning both the tyrosine level and that of the branched-chain amino acids. None of the patients who had surgical treatment showed clinica l evidence of hepatic encephalopathy. Regarding the results in the fli cker photometry, the non-shunted cirrhotic patients differed significa ntly from the healthy control subjects. For both the shunted and non-s hunted cirrhotic patients, the results of the Viennese determination t est and the number connection test indicated subclinical encephalopath y. We conclude that the elevated ammonia level in patients with porto- systemic anastomosis does not cause a significant mental disturbance. In well-selected patients, the portosystemic end-side shunt is an appr opriate procedure in the treatment of esophageal varices.