Hepatic encephalopathy should be diagnosed early and managed appropriately.Appearance of Hepatic Encephalopathy suggests poor prognosis in a patient with liver disease.
What is heapatic encephalopathy ?
Patients with liver failure experience altered mental status and decline in cognititve function attributed to porto systemic shunting.
Why does it occur ?
Liver is the major detoxification center in the body When liver fails,toxins that are normally cleared by the liver are retained in the circulation.
What are the molecules involved ?
Over the years, the understanding of hepatic encephalopathy has evolved.Originally ammonia was thought to be the major contributor of neurological manifestations.With the consistent finding that blood ammonia levels corelates poorly with severity and symptoms of Heaptic encephalopathy, other compounds like gamma-aminobutyric acid (GABA), mercaptens and unidentified neuro transmitters are thought to play a role.
What is the prevalence of Hepatic Encephalopathy ?
Hepatic Encephalopathy occurs in all cases of fulminant hepatic failure and is required to make a diagnosis of the later. More than half of patients with end-stage liver disease requiring transplantation have Heaptic Encephopathy More than 30 percentage of cirrhotics will experience Hepatic Encephalopathy at some point in the course of the disease.
What are the Precipitating factors ?
Hypokalemia, Infection, Increased protein in diet and electrolyte disturbances have been stongly associated.
What are the signs and symptoms ?
Altered in level of consciousness
Lethargy, coma
Normal electroencephalogram (EEG)
Asterixis(Flapping Tremor)
How to treat hepatic Encephalopathy ?
Identification and avoidance/treatment of precipitating factors.
Lactulose, dosed adequately to ensure 2-3 soft stools per day.
Rifamixin 550 mg twice daily
Zinc supplementation.
Free Powerpoint(PPT) Presentations:
Introduction to Hepatic Encephalopathy
Hepatic Encephalopathy
Fulminant Hepatic Failure