McLin V.: SLIPS
So many links between liver and brain!
Today’s guest on the ESPGHAN podcast is Prof Dr Valérie McLin, a Scots Bruxelloise living and working in Geneva, where at the University Hospital she heads the department of paediatric gastroenterology, hepatology, and nutrition. There she has pursued a particular interest, that of blood flow through the liver and the effects that disorders of hepatic perfusion have on both intellection and the physiology of intellection, or cerebration.
Manifest dysfunction of cerebration and thus of intellection resulting from liver disease is termed hepatic encephalopathy. It can occur with or without primarily disordered intermediary metabolism; congenital portosystemic shunts underlie some instances of hepatic encephalopathy without primary hepatocellular metabolic dysfunction. (Portosystemic shunting that results from vascular malformation rather than from hepatic scarring also may secondarily perturb intermediary metabolism.)
Dr McLin has substantially contributed to recognition that a spectrum exists of neurocognitive dysfunction in children with chronic liver disease or portosystemic shunting – berry-picking among initial letters has given the abbreviation SLiPS for such dysfunction. Hepatic encephalopathy in children, unlike in adults, may alter brain development as well as function. In consequence, successful palliation of liver disease in children – as with liver transplantation – may not entirely ameliorate cognitive deficits such as impaired attention, executive function, processing speed, and school performance. Structured neuropsychological assessment and interventional support thus are important for children with liver disease in all phases of their journey.
Dr McLin today offers three articles – bibliographic details are in the online précis of this session – as a basis for discussion. They are titled “Minimal hepatic encephalopathy in children with chronic liver disease: Prevalence, pathogenesis and magnetic resonance-based diagnosis”, by Srivastava et al.; “The current pediatric perspective on type B and C hepatic encephalopathy”, by McLin and D’Antiga; and “Neurometabolism and brain morphometry in an adolescent female with an extra-hepatic congenital portosystemic shunt”, by Chabbey et al.
Her perspectives on SLiPS follow, with her proposals for diagnosis of what can be subtle, easy-to-miss problems and suggestions on patient management.
Literature
Chabbey I et al. Neurometabolism and brain morphometry in an adolescent female with an extra-hepatic congenital portosystemic shunt. JPGN Rep. 2023 Dec 28;5(1):35–42. doi:10.1002/jpr3.12035. eCollection 2024 Feb. PMID: 38545268. PMCID: PMC10964341.
McLin VA, D’Antiga L. The current pediatric perspective on type B and C hepatic encephalopathy. Anal Biochem. 2022 Apr 15;643:114576. doi:10.1016/j.ab.2022.114576. Epub 2022 Jan 29. PMID: 35104444.
Srivastava A et al. Minimal hepatic encephalopathy in children with chronic liver disease: Prevalence, pathogenesis and magnetic resonance-based diagnosis. J Hepatol. 2017 Mar;66(3):528–536. doi:10.1016/j.jhep.2016.10.026. Epub 2016 Nov 1. PMID: 27815224.
Dr McLin´s favourite song: “Mon p’tit gars” – Drôles de Dames
ESPGHAN favourite Songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo