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"Because of the increasing burden of hepatitis C and fatty liver disease, there is an explosion in the prevalence of chronic liver failure and hence its complications. The onset of Hepatic Encephalopathy (HE) in these patients has a significant impact on the quality of life, morbidity and mortality. Unfortunately, the approach observed by most clinicians to this complex disorder is minimalistic.This book provides a comprehensive review on pathophysiology and clinically important aspects in HE. Topics in basic physiology, nitrogen metabolism, new insights into pathogenesis and brain edema are covered in great detail. The authors have made a special effort by simplifying the complex aspects of pathogenesis and diagnosis so that it can be easily understood and applied clinically. This volume also focuses on recent developments regarding diagnoses of subtle forms of HE, also known as minimal or covert HE as well as on new treatments. Hepatic Encephalopathy will be of great value to gastroenterologists, hepatologists, pathologists, medical residents, fellows, internists and general practitioners who treat patients with hepatic encephalopathy."

"Latar Belakang: Asam lemak rantai pendek (SCFA) merupakan metabolit utama yang diproduksi di kolon, hasil dari fermentasi bakteri terhadap serat dan resistant starch. SCFA diperkirakan memiliki peran pada patogenesis ensefalopati hepatik (EH), meskipun mekanisme yang mendasarinya belum sepenuhnya dimengerti. Disbiosis mikrobiota yang terjadi pada sirosis mengubah komposisi SCFA pada feses dan berperan dalam patogenesis EH.Tujuan: Penelitian ini bertujuan untuk membandingkan proporsi SCFA feses pasien sirosis yang mengalami EH dan non EH.Metode: Penelitian ini merupakan studi potong lintang yang dilaksanakan di Klinik Hepatobilier dan Ruang Prosedur Terpadu, IPINB Hepatobilier RSUP Dr. Cipto Mangunkusumo Jakarta periode 2023. Pasien sirosis akan dilakukan tes flicker atau stroop, pemeriksaan SCFA feses (asetat, butirat, dan propionat), dan kuesioner dengan teknik food recall untuk menilai pola diet. Analisis bivariat dan multivariat dilakukan dengan aplikasi SPSS Statistics (IBM, 2024).Hasil: 86 pasien sirosis dengan rerata usia 53 tahun ± 8,10 dan jenis kelamin mayoritas (68,6%) laki-laki mengikuti penelitian ini. 20 pasien sirosis (23,25%) mengalami EH. Analisa bivariat tidak ditemukan perbedaan bermakna (p>0,05) antara jumlah SCFA feses, komponen SCFA, ataupun proporsi komponen SCFA. Analisa multivariat terhadap proporsi SCFA absolut [OR 2,47; IK95% (0,64 – 9,56); p=0,191], proporsi asetat absolut [OR 4,72; IK 95%(0,25 – 64,01); p=0,243], dan proporsi butirat [OR 1,91; IK 95% (0,450 – 8,09); p=0,381] bersifat sebagai prediktor kejadian EH, sekalipun tidak bermakna.Simpulan: Prevalensi EH pada pasien sirosis rawat jalan di Poliklinik Hepatobilier RSCM adalah 23,3% dengan EH covert sebesar 19,8% dan EH overt sebesar 3,5%. Proporsi SCFA feses tidak berhubungan dengan kejadian EH pada pasien sirosis.

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Background: Short chain fatty acids (SCFA) are the main metabolites of the intestinal microbiota which play a role as colonocyte trophic factors and maintain the integrity of the gastrointestinal tract and blood-brain barrier. Microbiota dysbiosis that occurs in cirrhosis changes SCFA composition in feses and plays a role in the pathogenesis of hepatic encephalopathy (HE).

Objective: This study aims to compare the amount and composition of fecal SCFA in cirrhotic patients with HE and non-HE.

Methods: This research is a cross-sectional study carried out at the Hepatobiliary Clinic and Integrated Procedure Room, IPINB Hepatobiliary Hospital Dr. Cipto Mangunkusumo Jakarta period 2023. Cirrhosis patients will undergo a flicker or Stroop test, fecal SCFA examination (acetate, butyrate and propionate), and a questionnaire with a food recall technique to assess dietary patterns. Bivariate and multivariate analyzes were carried out with the SPSS Statistics application (IBM, 2024).

Results: 86 cirrhosis patients with a mean age of 53 years ± 8.10 and the majority gender (68.6%) male took part in this study. 20 cirrhosis patients (23.25%) experienced EH. Bivariate analysis found no significant differences (p>0.05) between the amount of fecal SCFA, SCFA components, or proportion of SCFA components. Multivariate analysis of absolute SCFA proportions [OR 2.47; IK95% (0.64–9.56); p=0.191], absolute proportion of acetate [OR 4.72; IK95% (0.25- 64.01); p=0.243], and the proportion of butyrate [OR 1.91; CI 95% (0.450 – 8.09); p=0.381] is a predictor of EH events, even though it is not significant. Conclusions: The prevalence of HE in outpatients with cirrhosis at the Hepatobiliary Polyclinic of RSCM was 23.3% with covert HE of 19.8% and overt HE of 3.5%. The proportion of fecal SCFA was not associated with the incidence of HE in cirrhosis patients."

"Sirosis hati merupakan salah satu masalah kesehatan yang terjadi pada masyarakat perkotaan. Keadaan malnutrisi ditemukan pada 65-90% pasien sirosis hepatis. Kondisi malnutrisi ini berhubungan dengan terjadinya komplikasi serius pada pasien sirosis hepatis, yaitu asites, ensefalopati hepatikum, dan kematian. Penelitian sebelumnya menunjukkan bahwa pemberian diet tinggi protein, khususnya yang kaya akan asam amino rantai cabang (AARC) dapat memperbaiki kondisi klinis pasien sirosis dan mengurangi komplikasi serius tersebut. Tujuan penulisan ini adalah untuk melakukan analisis evidence based mengenai pemberian AARC dalam memperbaiki kondisi klinis (nutrisi, nilai albumin, dan mengurangi terjadinya ensefalopati hepatikum). Hasilnya pada pasien ini adalah terbukti status nutrisi dapat ditingkatkan, tidak terjadi penurunan yang signifikan pada nilai albumin, dan tidak terjadi ensefalopati hepatikum. Rekomendasi penulisan ini adalah agar perawat memberikan pendidikan kesehatan tentang pentingnya diet tinggi protein yang kaya akan AARC.

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Cirrhosis hepatic is one of problem in urban health. Malnutrition is commonly found in 65-90% cirrhosis hepatic patients. This condition correlated with serious complications such as ascites, hepatic encephalopathy, and mortality. Previous researches recommend that high protein intake enriched in branched chain amino acids (BCAA) can improve clinical outcome of cirrhosis hepatic patients and reduce complications. This final clinical nursing report aimed to analyze evidence based about BCAA administered to improve clinical outcome (nutritional status, albumin, and reduce hepatic encephalopathy). The results showed that nutritional status improved, no decreased of albumin concentration, and hepatic encephalopathy not reported. It is recommended to deliver health education to patients about the important of high protein intake enriched in BCAA."

"ABSTRAKTujuan : Untuk menilai dan mengetahui pengaruh pemberian kombinasi asamamino rantai cabang (AARC) dengan L-ornitin L-aspartat (LOLA) larut malamterhadap status nutrisi dan ensefalopati hepatikum derajat rendah pada pasiensirosis hati.Metode : Populasi terjangkau penelitian adalah pasien poliklinik hati rumah sakitCipto Mangunkusumo periode Juni 2011 – Juni 2012 yang kemudian dilakukanevaluasi critical flicker frequency (CFF). Semua pasien yang masuk dalampopulasi penelitian adalah subjek penelitian yang memenuhi kriteria inklusipenelitian. Subjek penelitian kemudian diberikan edukasi diet sesuai dengankonsensus ESPEN. Subjek penelitian dibagi dalam 2 kelompok sesuai hasilrandomisasi, yaitu kelompok makanan selingan siang hari (MSSH) dan kelompokmakanan selingan malam hari (MSMH). Evaluasi terhadap anamnesis,pemeriksaan fisik, laboratorium dan CFF dilakukan 1 bulan setelah intervensi.Analisis statistik yang digunakan dalam penelitian uji acak tersamar tunggal iniadalah uji t independen.Hasil : Tiga puluh dua pasien yang sesuai dengan kriteria inklusi dibagi dalam 2kelompok intervensi. Kelompok A, MSSH (07.30 dan 12.30) dan kelompok B,MSMH (07.30 dan 22.30), masing-masing kelompok memiliki 16 subjekpenelitian. Setelah 1 bulan intervensi didapatkan hasil rerata lingkar lengan atas(LLA) kelompok MSMH (26.1±6.0 cm) (p = 0.001) dibandingkan kelompokMSSH (25.5±4.0 cm). Pada hasil CFF, didapatkan kelompok MSMH (39.5±3.9Hz) (p = 0.001) dibandingkan kelompok MSSH (38.4±4.2 Hz). Tidak didapatkanperbaikan kadar prealbumin dan derajat SGA setelah 1 bulan intervensi pada duakelompok. Hal ini dipikirkan karena perbedaan karakteristik dasar dan jumlahsampel yang relatif kecil.Simpulan : Proses randomisasi tidak berhasil menyamakan karakteristik dasarpada kedua kelompok. Terdapat peningkatan bermakna pada lingkar lengan atas,berat badan dan CFF setelah 1 bulan pemberian kombinasi AARC dan LOLAsebagai makanan selingan malam hari pada pasien sirosis hati.

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ABSTRACTAim : To determine the effect of L-ornithine L-aspartate (LOLA) and branchchain amino acids (BCAA) as a combination supplementation on nutritional statusand minimal hepatic encephalopathy improvement in liver cirrhosis patient.Methods : Liver cirrhosis patient in walk-in clinic of Cipto MangunkusumoHospital in June 2011 – June 2012 were evaluated by critical flicker frequency(CFF) test. Encephalopathy is defined when CFF < 38 Hz. All subjects whofulfilled the inclusion criteria received education for an adequate diet based on theESPEN Guidelines. They were divided into two groups based on randomization.One group was given the combination supplement as day snacks, while the othergroup as late evening snacks. The evaluation based on anamnesis, physicalfinding, laboratory result and CFF test after 1 month of interventions. Statisticalanalysis conducted for this single blind randomized clinical trial was independentt-test.Results : Thirty two patients who fit the inclusion criteria were divided into twogroups, group A : day snacks (7.30 am and 12.30 pm) and group B : late eveningsnacks groups (07.30 am and 10.30 pm), each groups has 16 subjects. Statisticalanalysis obtained the statistically significant (p = 0.001) of increasing of the meanmid arm circumference in group B (26.1±6.0 cm) compared to group A (25.5±4.0cm). Statistically significant (p = 0.001) were also revealed in mean CFF value ingroup B (39.5±3.9 Hz) compared to group A (38.4±4.2 Hz). However, the meanprealbumin level and SGA score after 1 month intervention in both groups wasnot met statistically significant, caused by the small subjects.Conclusion : The randomization process was not able to make a good comparisonin both groups. There is a significant increasing level of mid arm circumference,body weight and CFF after 1 month combination of LOLA and BCAA as lateevening snacks for liver cirrhosis patient."