Pathogenesis of hepatic encephalopathy and hyperdynamic syndrome in cirrhosis. Role of false neurotransmitters
A. Nespoli, G. Bevilacqua, C. Staudacher, N. Rossi, F. Salerno and M. R. Castelli
We sought to determine whether false neurotransmitters (FNTs) play an
important role as determinants not only of hepatic encephalopathy but also
of hyperdynamic syndrome in cirrhosis. A combined biochemical and
hemodynamics study of 55 bleeding cirrhotic patients was made. We evaluated
the aromatic and aliphatic branched-chain amino acids and octopamine serum
levels as well as the hemodynamic measurements. The results show that there
is a correlation between levels of serum octopamine and aromatic amino
acids and hepatic coma: the higher the octopamine level, the deeper the
hepatic coma. There is also a correlation between aromatic amino acids and
cardiac index and total peripheral resistance. Furthermore, when a
narrowing of arteriovenous difference in oxygen occurs and oxygen
consumption decreases, there is an increase not only in the level of
aromatic amino acids, but also in octopamine level, suggesting an important
linkage between hemodynamic and metabolic impairment.
