Hepatic encephalopathy and orotic aciduria associated with hepatocellular carcinoma in a noncirrhotic liver

Lennox J. Jeffers, Richard A. Dubow, Leslie Zieve, K. Rajender Reddy, Alan S. Livingstone, Sidney Neimark, Manuel Viamonte, Eugene R. Schiff

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

A 40-yr-old man presented with encephalopathy and was found to have hepatocellular carcinoma without cirrhosis. A large vascular hepatic mass was defined by CT scan and angiography; laparoscopy with biopsy confirmed the absence of chronic liver disease. A definitive tissue diagnosis of hepatocellular carcinoma was made at laparotomy; the tumor was unresectable. Peripheral arterial and selective portal and hepatic venous ammonia levels were high, and this finding suggested that the encephalopathy was nitrogenous and hepatic in origin. The proposed mechanisms of the encephalopathy are generation of ammonia from tumor breakdown and portosystemic shunting, a result of partial tumor occlusion of the hepatic veins. An unusually high urinary excretion of orotic acid was found similar to that seen in hereditary orotic aciduria.

Original languageEnglish (US)
Pages (from-to)78-81
Number of pages4
JournalHepatology
Volume8
Issue number1
DOIs
StatePublished - Jan 1 1988

ASJC Scopus subject areas

  • Hepatology

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