Cerebral blood flow in fulminant hepatitis

Transplantation Proceedings
P FeltraccoF Salvaterra

Abstract

Fulminant hepatic failure (FHF) is often complicated with cerebral edema, intracranial hypertension, and coma. Cytotoxic and vasogenic factors have been recognized in the etiology of cerebral edema. One of the main causes seems to be the accumulation of glutamine in astrocytes, which is produced from ammonia and the excitatory neurotransmitter glutamate. Ammonia is detoxified within the brain in astrocytes, where it increases the osmotic pressure for water. Ammonia-induced astrocytic water accumulation seems to act as an integrative trigger for the development of intracranial hypertension. While cerebral blood flow is sometimes reduced in the first stage of FHF, as compensatory cerebral vasoconstriction to reduce mean arterial pressure, it later increases as hyperammonemia decreases cerebral arteriolar tone. Despite vasodilation in the systemic and splanchnic beds at early stages of the disease, cerebral vessel resistance may increase, so that cerebral perfusion pressure may be preserved. When cerebral vascular tone is no longer effective in the course of illness, vasodilation gradually develops and rapidly becomes poorly responsive to carbon dioxide stimulation, which signifies loss of autoregulatory tone and cerebral hyperemi...Continue Reading

References

Jun 1, 1994·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·J A WendonR Williams
Apr 1, 1997·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·G StraussF S Larsen
Sep 1, 1996·Liver Transplantation and Surgery : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·F S LarsenB A Hansen
Sep 26, 2000·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·N RolandoR Williams
Nov 21, 2000·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·F S LarsenB A Hansen
Nov 20, 2003·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Gitte Irene StraussGitte Moos Knudsen
Feb 10, 2004·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Fin Stolze Larsen

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Citations

Dec 18, 2007·Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses·Joseph R SpaniolJanet D Pierce
Oct 7, 2011·Beilstein Journal of Nanotechnology·David KlockeHelmut Schmitz

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