Hepatic Encephalopathy, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Hepatic Encephalopathy, Diagnosis and Treatment and Related DiseasesHepatic encephalopathy happens when the liver is not able to eliminate toxins from the blood. This is called loss of brain function following the continual liver disease. This disorder may occur suddenly or develop slowly over time. Hepatic encephalopathy, a disorder present in some patients with cirrhosis, may present with personality changes, intellectual impairment, and a reduced level of consciousness.
The diversion of portal blood into the systemic circulation seems to be a factor for the syndrome. Hepatic encephalopathy is regarded as a group of neuropsychiatric abnormalities in patients with liver failure, after exclusion of other known brain disease. Hepatic encephalopathy can be subdivided into covert hepatic encephalopathy and overt hepatic encephalopathy. Covert hepatic encephalopathy is a sub-medical, less severe presentation of hepatic encephalopathy and needs psychometric testing for diagnosis.
Overt hepatic encephalopathy has an important impact on a patient's quality of life, such as employment and driving ability and is linked with higher admissions to hospital and with deathCausesAn important function of the liver is to convert toxic substances in the body to harmless material. When the liver is injured, these toxins can accumulate in the bloodstream and impair the function of the nervous system.
This disorder can happen suddenly and the patient may become ill very quickly. Frequent causes of chronic liver disease in the USA are:1. Chronic hepatitis B or hepatitis C infection2. Alcohol abuse3. Autoimmune hepatitis4. Bile duct disorders4. Some medicines5. Non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)Once the patient has liver damage, episodes of worsening brain function may be triggered by:1.
Body is low on water or fluids2. Eating too much protein3. Low potassium or sodium levels4. Bleeding from the intestines, stomach, or esophagus5. Infections6. Kidney disorders7. Low oxygen levels in the body8. Shunt placement or complications9. Surgery10. Narcotic pain or sedative medicinesVarious hypotheses have been proposed to clarify the pathogenesis of hepatic encephalopathy in patients with liver cirrhosis.1.
Changed brain energy2. Ammonia hypothesis3. GABA hypothesisEarly symptoms may be mild and are:1. Breath with a musty or sweet odor2. Change in sleep patterns3. Changes in thinking4. Confusion that is mild5. Forgetfulness6. Mental fogginess7. Personality or mood changes8. Poor concentration9. Poor judgment10. Worsening of handwriting or loss of other small hand movementsMore severe symptoms may be:1.
Abnormal movements or shaking of hands or arms2. Agitation, excitement, or seizures (occur rarely)3. Disorientation4. Drowsiness or confusion5. Strange behavior or severe personality changes6. Slurred speech7. Slowed or sluggish movementPeople with hepatic encephalopathy can become:1. Unconscious, 2. Unresponsive, and3. Possibly enter a comaDiagnosisSigns of nervous system changes such as confusion, flapping of handsSigns of liver disease such as jaundice and ascitesAbnormal liver functionArterial ammonia levels are raisedMRI of brain and liverTreatmentAn assessment of the blood ammonia level may be useful in such patients.
Precipitants of hepatic encephalopathy should be corrected (e.g., hypovolemia, metabolic disturbances, GI bleeding, infection, constipation). LactuloseAntibiotics such as neomycin and RifaximinProtein restrictionFlumazenil (benzodiazepine antagonist)L-ornithine L-aspartateSodium benzoateTABLE OF CONTENTIntroductionChapter 1 Hepatic Encepha...