Therefore, we consider it likely that our patients developed liver insufficiency due to a prolonged state of severe malnutrition and anorexia, which was not well recognized.
Liver insufficiency has been described after malabsorptive bariatric procedures, such as the Scopinaro procedures. Bacterial overgrowth with the production of hepatotoxic macromolecules was considered the main cause. Malnutrition as cause of liver insufficiency is rare and has been described in non-bariatric patients with anorexia nervosa. The following hypotheses have been proposed in the literature: Liver insufficiency may be caused by acute liver cell necrosis, the result of autophagy[ 11 ] or dehydration and hypovolemia with poor blood circulation through the liver[ 12 ].
We hypothesize that our patients developed anorexia following bariatric surgery, reaching a state of starvation and a critical level of the liver reserve capacity, finally resulting in a state of liver insufficiency and death. In conclusion, liver failure due to severe malnutrition is a very rare but critical complication after bariatric surgery. Patients who underwent bariatric surgery in the past developed unconsciousness and liver failure after self-induced food restriction.
Hypoglycemia or neurological disorders were excluded as the cause of unconsciousness. No viral, autoimmune or toxic agents were found to have caused the liver failure. Signs of severe hypoalbuminemia, liver failure and hyperammonemia. Informed consent statement: Patients were not required to give informed consent to this study, because the case report was written after the patients received agreed to and necessary treatments.
All patient data were handled as anonymous. Conflict-of-interest statement: All authors certify that they have no affiliations with or involvements in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.
Manuscript source: Unsolicited manuscript. Peer-review started: December 13, First decision: January 15, Article in press: February 7, Specialty type: Gastroenterology and hepatology. Country of origin: the Netherlands. Peer-review report classification. Grade A Excellent : A.
Grade B Very good : 0. National Center for Biotechnology Information , U. Journal List World J Hepatol v. World J Hepatol. Published online Mar Author information Article notes Copyright and License information Disclaimer. Author contributions: Lammers WJ contributed to drafting of the manuscript; all authors contributed to acquisition of data, interpretation of data and critical revision of the manuscript for important intellectual content. Published by Baishideng Publishing Group Inc.
All rights reserved. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. This article has been cited by other articles in PMC. Abstract Bariatric surgery is an effective tool in the treatment of patients with morbid obesity.
Table 1 Results of liver test at presentation of hyperammonemic encephalopathy. Open in a separate window. Clinical diagnosis Development of hepatic encephalopathy and hepatic failure. Differential diagnosis Hypoglycemia or neurological disorders were excluded as the cause of unconsciousness. Laboratory diagnosis Signs of severe hypoalbuminemia, liver failure and hyperammonemia.
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Macbeth, E. Kass, and W. Mcdermott Jr. Loguercio, C. Del Vecchio Blanco, and M. Serum albumin and pre-albumin are not reliable in assessing for malnutrition when liver disease is present.
Laboratory measurement of micronutrients may be performed if etiology of sign or symptom is unclear or if there is concern for possible toxicity see below. Specific considerations can include low fat-soluble vitamin levels in cholestatic liver disease such as primary biliary cholangitis PBC and primary sclerosing cholangitis PSC. It is desirable for individuals to meet their calorie and protein needs with normal food whenever safe and possible.
If necessary, tube feedings are given per nasoenteral tubes rather than percutaneous tubes which are considered unsafe in the presence of gastric varices or ascites. Veterans Crisis Line: Press 1. Complete Directory. If you are in crisis or having thoughts of suicide, visit VeteransCrisisLine. Quick Links. Nutrition and Cirrhosis for Health Care Providers.
Nutrition and Cirrhosis - Cirrhosis. Related Resources. Nutrition Information for Patients.
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