Several issues were discussed regarding the management strategies for hepatic encephalopathy as well as the optimum evaluation of patietns for suspected SBP.
A recent Medical Clinics of North America (July 2009) has an excellent review of hepatic encephalopath and treatment and is avaialbale through the MD Consult core collection:
http://www.mdconsult.com/das/article/body/182021411-2/jorg=journal&source=&sp=22299341&sid=0/N/704543/s0025712509000406.pdf?issn=0025-7125
The article covers pathophysiology, staging, and reviews the literature on effective therapies. Interestingly, testing for zinc deficiency and supplementing those with low levels seems to improve cognitive function according to a few studies referenced in that article.
When to perform paracentesis to evaluate for SBP is addressed in the following article from JAMA (March 12, 2008 issue). That article states a 27% rate of infection in cirrhotic patients with ascites admitted to the hospital for complications of cirrhosis. Fever is often absent, but when present paracentesis should always be part of the workup. Paracentesis should also be considered in any cirrhotic presenting with nausea, abdominal pain, or altered mental status. This article summarizes the data regarding interpretation of results and treatment options for SBP. Consider primary prophylaxis for SBP in cirrhotics with low-protein ascites, and secondary prophylaxis in anyone with previous SBP. This is the article I will use for sim center teaching when the model is available later this year, so know it and know it well.
http://jama.ama-assn.org/cgi/reprint/299/10/1166
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
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