Endotoxins, ammonia, Fatty Liver, and Hepatic Fibrosis
Objective of the Review: To summarise new information regarding hepatic diseases pathogenesis and clinical study results, and also to develop a practical algorithm for hyperammoniemia correction in hepatic diseases. Key Points: In hepatic diseases pathogenesis, toxic effect from ammonia over star cells is seen as one of the fundamental pathogenic processes of fibrosis and hepatic continuum in general. The key role in asthenia pathogenesis in case of fatty liver disease and encephalopathy accompanying fibrosis and cirrhosis is played by hyperammoniemia. Conclusion: The optimal way to manage hyperammoniemia (a method of pathogenic therapy for hepatic diseases) is a course of L-ornithine-L-aspartate in order to reduce star cells activation. A routine screening for asthenia and minimal or latent encephalopathy using clinical evaluation and a number connection test is a mandatory procedure.