Hepatic Encephalopathy
Liver disease that involves loss of cells (hepatocytes) and irreversible scaring of the liver,cirrhosis as in itself is not infectious
CAUSES
Hepatic failure (liver cells failure) due to
Hepatic encephalopathy may be triggered by:
- Infections such as pneumonia
- Kidney problems
- Dehydration
- Hypoxia, or low oxygen levels
- Recent surgery or trauma
- Medications that suppress your immune system
- Eating too much protein
- Medications that suppress your central nervous system, such as barbiturates or benzodiazepine tranquilizers
- Electrolyte imbalance, especially a decrease in potassium after vomiting or taking diuretics
CLINICAL FEATURES
A. Disturbance in consciousness
- Disturbances in sleep rythm
- Impaired memory
- Mental confusion
- Apathy
- Coma
B. Changes behaviour
- Childish behaviour
- May be aggressive outburst
- Euphoric
SIGNS AND SYMPTOMS
Symptoms and signs of moderate hepatic encephalopathy may include:
- Difficulty thinking;
- Personality changes;
- Poor concentration;
- Problems with handwriting or loss of other small hand movements
- Confusion
- Forgetfulness
- Poor judgment
- A musty or sweet breath odor
Symptoms of severe hepatic encephalopathy are:
- Confusion
- Drowsiness or lethargy
- Anxiety
- Seizures
- Severe personality changes
- Fatigue
- Confused speech
- Shaky hands
- Slow movements
INVESTIGATION
- Diagnosis is usually made clinically
- Routine investigations include: l fts, electrolytes, urea, creatinine
- Elevation of blood ammonia
- CSF & CT scan
MANAGEMENT
- Supportive treatment
- Specific treatment aims at: decreasing ammonia production in colon
