EH es un desorden metablico que afecta al snc.

Este desarrolla enfermedades hepticas

secundarias (hepatopatas) una en encefalopata es un trmino medico para cualquier
desorden del cerebro. EH es causada por una acumulacin de amoniaco en el sistema
debido a la inestabilidad heptica para deshacerse de la substancia
http://www.petmd.com/dog/conditions/endocrine/c_dg_hepatic_encephalopathy?page=
show
Hepatic encephalopathy (HE) develops in certain liver disorders associated with
portosystemic shunting or fulminant hepatic failure. Clinical signs vary but involve
disturbed sensorium ranging from mild dullness and an inability to respond to basic
commands to overt abnormalities, including propulsive circling, head pressing, aimless
wandering, weakness, ataxia, amaurosis (unexplained blindness), ptyalism, dementia,
behavior change (eg, aggression), collapse, seizures, and coma. Although the
pathophysiologic mechanisms of HE are not completely known, synergistic effects
between the failure of the liver to detoxify ammonia and other endogenous substances,
increased cerebral inflammatory cytokines, impaired brain perfusion, development of
neuronal edema, hypoxia, mitochondrial dysfunction, development of neuroglycopenia,
and oxidative injury, are important interdependent mechanisms. Increased production of
reactive oxygen and nitrogen oxide species are thought to trigger protein and RNA
modifications that deleteriously influence brain function. The integrated concept of HE
explains episodic variability and heterogeneous precipitating factors that correlate with
diverse clinical scenarios.
Ocurre con ciertos desordenes hepticos asociados con un shunt porto-sistemtico o falla
heptica fulminante. Los signos varan pero involucra distorsin sensorial que va desde
debilidad leve y una inhabilidad de responder a comandos bsicos, anormalias
manifestadas, locomocin circular, presin de la cabeza contra objetos, deambular sin
rumbo, debilidad, ataxia, amaurosis, ptialismo, demencia, cambio de comportamiento,
colapso, convulsiones y coma. A pesar de que el mecanismo patofisiologico de EH no es
completamente conocido, efectos sinrgicos entre la falla del hgado al desintoxicarse de
amoniaco y otras sustancias endgenas, incrementan inflamacin de las citocinas del
cerebro, deteriorando perfusiones cerebrales, desarrollando un edema neural, hipoxia,
disfuncin mitocondrial, desarrollo de una neuroglucopenia y daos oxidativos, que son
importantes mecanismos interdependientes.
Ammonia can influence multiple neurotransmitter systems directly (chemical influence)
and indirectly (altered substrate availability for transmitters). There is substantial evidence
that astrocytes play an important role in the pathogenesis of HE. Ammonia and other
endogenous products, inflammatory cytokines, and hyponatremia (associated with portal
hypertension) induce astrocyte swelling that can lead to brain edema and herniation most
common in acute liver failure and acute severe HE.

El amoniaco puede influir en muchos sistemas de neurotransmisores directamente e

indirectamente. Esto es evidencia substancial que los astrocitos juegan un papel
importante en la patognesis de EH. Amoniaco y otros productos endgenos, citocinas
inflamadas y una hiponatremia inducen a una hinchazn de los astrocitos que puede llevar
a un edema y una hernia ms comn en fallo heptico agudo y EH severo agudo.
http://www.merckmanuals.com/vet/digestive_system/hepatic_disease_in_small_animals
/hepatic_encephalopathy_in_small_animals.html
associated with:
Portosystemic shunt
Liver mass reduction associated with lobectomy
Congenital diseases - e.g. defects of enzymes of the urea cycle, arginine deficiency or
organic acidaemias
Hypokalemia
Constipation
Gastrointestinal hemorrhage - e.g. canine parvovirus
High dietary protein, purine or methionine content
Uremia
Portal hypertension and portal vein aneurysm
Congenital hepatic fibrosis
Arterioportal fistula
Chronic hepatitis
Encapsulating peritoneal sclerosis
Dehydration
Caroli disease
Asociado con: shunt portosistematico,desihadratacion, esclrerosis peritoneal encapsulada,
hepatitis cronica, fistula arteriportal, enfermedad de caroli,fibrosis heptica congenital,
hipertencion portal y aneurisma de la vena porta, uremia, dieta de alta protena,
hemorragia gastrointestinal, constipacin y una hipokaliemia
Hepatic encephalopathy is not a diagnosis per se, rather a clinical state due to an
underlying disease. Elevated levels of circulating ammonia are confirmatory of this
condition, but a full investigation of cause is required to establish a correct diagnosis.
EH no es un tipo de diagnostico de por s, es ms bien un estado clnico que es debido a
una enfermedad subyacente. Niveles elevados de amoniaco circulando son confirmadores
de esta condicin, pero una investigacin de la causa es requerido para establecer un
diagnostico correcto.

Clinical Signs
Four clinical stages have been described for hepatic encephalopathy:
Stage I: Mild changes in mentation; this stage is usually missed in horses.
Stage II: Depressed mental state, lethargy, behavioural changes, head pressing, ataxia and
dysphagia.
Stage III: Somnolent but rousable. Reactions may be very reduced or exaggerated.
Stage IV: Coma, Seizures are rare but may occur in the late stages of the condition.
Signos clnicos
Fase 1: cambios mentales menores (usualmente desapercibida en caballos)
Fase 2: estado de depresin mental. Letargia, cambios de actitud, ataxia
Fase 3: somnoliento pero atento.las Reacciones pueden variar o exagerar.
Fase 4: coma, raros casos de epilepsia pueden ocurrir en los ltimos estados de esta
condicin
http://www.vetbook.org/wiki/dog/index.php/Hepatic_encephalopathy
Diagnosis
You will need to give a thorough history of your dogs health, onset of symptoms, and any
background information you have on your dogs parentage. Your veterinarian will perform
a complete physical exam on your dog, with standard tests including a blood chemical
profile, a complete blood count, an electrolyte panel and a urinalysis so as to rule out
other causes of disease. Your veterinarian will use the bloodwork to confirm or rule out
impaired kidney function.
X-ray and ultrasound imaging will allow your veterinarian to visually examine the liver. Its
appearance will change in certain diseased states. If this appears to be the case your
veterinarian may take a sample from the liver by aspiration or biopsy in order to reach a
conclusive diagnosis.
Obtener el historial complete de la salud del paciente, sntomas iniciales, y cualquier
informacin de fondo acerca de su parentesco. Examen fsico completo, exmenes de
sangre, un uro anlisis. Y confirmar el anlisis de sangre o descartar funcin renal
despareja.
Rayos x e imagines de ultrasonido ayudan a un examen visual del hgado.la apariencia del
hgado cambia con la fase en la que se encuentre. Y para un diagnostico conclusivo se
hace una biopsia
http://www.petmd.com/dog/conditions/endocrine/c_dg_hepatic_encephalopathy?page=
show
Treatment
With supportive therapy horses may recover from hepatic encephalopathy after 4-21
days. Treatment is only warranted in acute cases likely to make a recovery.

Sedation is often necessary in cases of hepatic encephalopathy; An alpha 2 agonist at a

low dose is usually effective.
Lactulose, mineral oil and neomycin or metronidazole can be administered in an attempt
to reduce the production and absorption of hepatic toxins.
Tratamiento
Con terapia de apoyo en caballos podria haber recuperacion de EH despues de 4-21 dias.
El tratamiento es solo garantizado en casos agudos comunes a recuperarse.
A menudo sedar es necesario en casos de EH; un alfa 2 agonista en bajas dosis es efectivo
usualmente.
Lactulose, aceite minela y neomicina o metromidazole puese ser administrado en un
intento de reducir la produccin y absorcin de toxinas hepticas.
http://en.wikivet.net/Hepatic_Encephalopathy_-_Horse

Enfermedad de Caroli
La Enfermedad de Caroli es un raro desorden hereditario caracterizado por la dilatacin
de los ductos biliares intrahepticos. Se consideran dos subtipos de enfermedad de Caroli,
siendo el ms frecuente llamado simple o aislado y se presenta cuando los ductos biliares
se encuentran dilatados por ectasia. El segundo subtipo, ms complejo, se conoce
comnmente como sndrome de Caroli. Esta forma compleja se encuentra vinculada
a hipertensin portal y fibrosis heptica congnita.1