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Abstrak :
Background Hepatic encephalopathy is found in 50-70% cases of liver cirrhosis. Management of hepatic encephalopathy is based on the hypothesis of ammonia and false neurotransmitters. A vegetable diet is the diet of choice, since vegetable proteins have a high biological value, contains non-ammonigenic essential amino acids, and contains fiber. The results of soy fermentation by Rhizopus sp can increase the nutritional value to make it easier for body digestion. Study aim To determine improvements in hepatic encephalopathy by measuring the ammonium level and determining the psychometric test in patients with liver cirrhosis receiving a tempe diet compared to those receiving a liver diet (conventional diet). Method This is a random open clinical trial with a proportional stratification according to the Child Pugh criteria. Study subjects are patients with liver cirrhosis who are hospitalized at the Internal Medicine Ward and ambulatory patients at the out-patient Gastro-hepatology Polyclinic of Dr. Sarjito Public General Hospital, from January 1999 to May 2000. The trial was conducted for 20 days, where the first (trial) group was given a tempe diet, while the second (control) group was given liver diet Will (conventional). Measured outcomes include peripheral blood ammonium level, and psychometric test using the Numeric Connection Test (NCT). Results In the first group, we found a significant reduction of ammonium level in Child-Pugh A patients and a non-significant reduction in Child-Pugh B/C patients, a non-significant psychometric test improvement in Child-Pugh A patients, and significant psychometric test improvement in Child-Pugh B/C patients. In group II: there is no significant difference in the changes in ammonium level or psychometric test in patients from both Child-Pugh categories. Conclusion A 20-day tempe diet can reduce ammonium levels and improve results on the psychometric test. Key words: liver cirrhosis, hepatic encephalopathy, tempe diet, numeric connection test, Child-Pugh criteria

Abstrak :
Background: alcohol may have additional neurotoxic ill-effects in patients with alcohol related cirrhosis apart from hepatic encephalopathy. We aimed to evaluate minimal hepatic encephalopathy (MHE) with Psychometric Hepatic Encephalopathy (PHES) score and Critical Flicker Frequency (CFF) in alcohol (ALD) and non-alcoholic steatohepatitis related (NASH) related cirrhosis. Methods: 398 patients were screened between March 2016 and December 2018; of which 71 patients were included in ALD group and 69 in NASH group. All included patients underwent psychometric tests which included number connection test A and B (NCT-A and NCT-B), serial dot test (SDT), digit symbol test (DST), line tracing test (LTT) and CFF. MHE was diagnosed when their PHES was <-4. Results: the prevalence of MHE was significantly higher in ALD group compared to NASH (69.01% vs 40.58%; P=0.007). The performance of individual psychometric tests was significantly poorer in ALD (P<0.05). Overall sensitivity and specificity of CFF was 76.62% (95%CI 65.59 – 85.52) and 46.03% (95%CI 33.39 – 59.06) respectively. Mean CFF was significantly lower in ALD than NASH (37.07 (SD 2.37) vs 39.05 (SD 2.40), P=0.001); also in presence of MHE (36.95 (SD 2.04) vs 37.96 (SD 1.87), P=0.033) and absence of MHE (37.34 (SD 3.01) vs 39.79 (SD 2.46), P=0.001). Conclusion: MHE is significantly more common in patients with ALD cirrhosis than NASH counterparts. Overall CFF values are less in alcohol related cirrhosis than NASH related cirrhosis, even in presence or absence of MHE. We recommend additional caution in managing MHE in ALD cirrhosis.

Abstrak :
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.

Abstrak :
ABSTRAK Latar Belakang: Ensefalopati hepatikum minimal (EHM) adalah spektrum teringan dari abnormalitas neuropsikologis yang merupakan komplikasi dari sirosis hati yang berimplikasi pada kualitas hidup pasien. Namun, saat ini modalitas untuk mendiagnosis EHM masih terbatas. Salah satu modalitas pemeriksaan EHM adalah Critical Flicker Frequency (CFF), namun tidak semua fasilitas kesehatan memiliki alat ini. Model for End-Stage Liver Disease (MELD) adalah suatu sistem skoring yang dikembangkan untuk mengetahui prognosis pasien yang akan menerima transplantasi hati dan berdasarkan beberapa studi, berkorelasi dengan EHM. Penelitian ini bertujuan untuk mengetahui korelasi antara MELD dengan CFF pada pasien sirosis hati. Metode: Penelitian dilakukan secara potong lintang. Pengambilan data dilakukan sejak Maret hingga Mei 2016 di poliklinik Hepatologi RSUPN Cipto Mangunkusumo. Kriteria inklusi meliputi pasien sirosis hati dengan nilai Glasgow Coma Scale (GCS) 15. Kriteria eksklusi meliputi pasien dengan ensefalopati hepatikum, hematemesis melena, stroke, gangguan penglihatan dan sirosis alkoholik, Subjek penelitian kemudian dilakukan pemeriksaan dengan alat CFF dan dihitung skor MELD masing masing. Hasil: Sebanyak 60 pasien memenuhi kriteria inklusi dan eksklusi. Didapatkan 28 pasien tanpa EHM dan 32 pasien dengan EHM. Rata rata usia pasien 54,8 tahun. Jumlah hepatitis terbanyak adalah hepatitis B sejumlah 34 pasien dan skor Child Pugh terbanyak adalah Child Pugh A sebanyak 39 pasien. Nilai rerata CFF 36,9 ± 8,57 Hz dan skor MELD 10,3 ± 3,6. Didapatkan nilai r -0,097. Simpulan: Tidak terdapat korelasi antara skor MELD dan skor CFF.

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ABSTRACT Background: Minimal hepatic encephalopathy (MHE) is the mildest spectrum of neuropsychological abnormality as a complication of liver cirrhosis which has implication in quality of life. Meanwhile, there are only few modalities to diagnose MHE. One of them is Critical Flicker Frequency(CFF), but this modality is not available in every health center. Model for End-Stage Liver Disease (MELD)-a scoring system developed to determine the prognosis of patients who receive liver transplant-is correlated with EHM according to several studies. This study aimed to determine the correlation between MELD with CFF in cirrhotic patients. Method: This was a cross sectional study. Data were collected from March until May 2016 in Hepatological outclinic RSUPN Cipto Mangunkusumo. Inclusion criteria consist of cirrhosis pasien with Glasgow Coma Scale (GCS) 15. Exclution criteria consist of patient with hepatic encephalopathy, hematemesis melena, stroke, visual impairment, and alcoholic cirrhosis. All subjects were examined using CFF and MELD scores. Results: A total of 60 patients met the inclusion and exclusion criteria for the study. There are 28 patients with EHM and 32 patients without EHM. r value of -0,097. The mean age were 54.8 years old. Most subjects were diagnosed with hepatitis B (34 patients) and most subjects were scored A based on Child Pugh scoring(39 patients). Mean value of CFF and MELD are 36,9 ±8,57 Hz and 10,3 ±3,6 consecutively. The correlation score between two modalities were r -0,097. Conclusion: There was no correlation between MELD score and CFF score.