Anatomic arrangement of the liver lobes and extrahepatic biliary tract. A, Diaphragmatic aspect of the liver. B, Visceral aspect of the liver. C, Liver lobes, gallbladder, and hepatic ducts, visceral aspect. (From Evans HE: The digestive apparatus and abdomen. In Evans HE, de Lahunta A: Miller’s anatomy of the dog, ed 4, St Louis, 2013, Saunders/Elsevier.) Hepatic encephalopathy (HE) is a brain disturbance caused by liver dysfunction. When the liver can no longer clear toxins

Lactulose is one of the main medicines used to manage hepatic encephalopathy (HE). It is a special sugar the body cannot digest, so it travels intact to the colon — and there it does something clever. It changes the chemistry of the gut so that ammonia, the main toxin behind HE, gets trapped inside the bowel and carried out in the stool instead of being absorbed into the blood and reaching the brain. How it works, step by step: Lactulose enters the colon. Given by mouth, it p

Introduction For a congenital portosystemic shunt — the most common cause of hepatic encephalopathy in young dogs and cats — the definitive treatment is surgery to correct the abnormal vessel. The goal is to close the shunt so that blood from the gut once again flows through the liver to be detoxified, instead of bypassing it. Crucially, the shunt is closed gradually rather than all at once. Before surgery: Portal blood bypasses the liver through the shunt vessel Ammonia and

What Is Hepatic Encephalopathy? Anatomic arrangement of the liver lobes and extrahepatic biliary tract. A, Diaphragmatic aspect of the liver. B, Visceral aspect of the liver. C, Liver lobes, gallbladder, and hepatic ducts, visceral aspect. (From Evans HE: The digestive apparatus and abdomen. In Evans HE, de Lahunta A: Miller’s anatomy of the dog, ed 4, St Louis, 2013, Saunders/Elsevier.) Consider your pet’s liver as the body’s main chemical processing plant — it handles all s

Introduction Figure I: Kidney illustration Renal encephalopathy, also known as uraemic encephalopathy (UE), is a severe, life-threatening metabolic neurological disorder caused by advanced renal (kidney) failure. It occurs when the kidneys fail to filter out organic wastes, leading to an accumulation of uraemic toxins (nitrogenous toxins) in the blood and central nervous system (CNS). Besides, it also causes electrolyte imbalances, leading to metabolic acidosis, and often sys