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DR. Prof. Balvir Singh
(MBBS. M.D. Medicine ,MNAMS,FICP,FIACM)
Hepatic encephalopathy
Hepatic encephalopathy is a neuropsychiatric
syndrome caused by hepatic insufficiency
It represents...
Causes:
 Chronic parenchymal liver disease:
 Chronic hepatitis:
 Cirrhosis.
 Fulminating hepatic failure:
 Acute vira...
Factors precipitating hepatic encephalopathy:






Metabolic stress
 Infection
 Electrolyte imbalance, especially hy...
PATHOPHYSIOLOGY
Clinical Features of hepatic
encephalopathy:
A Disturbance in consciousness
 Disturbances in sleep rhythm.
 Impaired mem...
B. Changes Personality
 Childish behavior.
 May be aggressive out burst.
 Euphoric.
 Foetor hepaticus – Foul–smelling
...
C Neurological signs:
 Flapping tremor / Asterixis (in pre
coma).
 Exaggerated tendon reflex.
 Extensor plantar reflex.
Clinical stages of Hepatic Encephalopathy
Investigations
Diagnosis is usually made clinically
 No Pathognomonic liver function
abnormality
 Elevation of blood amm...
Differential Diagnosis
 Subdural Haematoma
 Drug or Alcohol intoxication
 Wernicke’s encephalopathy
 Hypoglycaemia
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
Hepatic encephalopathy presentation latest aspect
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Hepatic encephalopathy presentation latest aspect

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Transcript of "Hepatic encephalopathy presentation latest aspect"

  1. 1. DR. Prof. Balvir Singh (MBBS. M.D. Medicine ,MNAMS,FICP,FIACM)
  2. 2. Hepatic encephalopathy Hepatic encephalopathy is a neuropsychiatric syndrome caused by hepatic insufficiency It represents a reversible decrease in neurologic function, based upon the disorder of metabolism which are caused by severe decompensated liver disease “Portal-systemic encephalopathy” - patients with portal hypertension abnormal shunting of blood It occurs most often in patients with cirrhosis but also occur in acute hepatic failure.
  3. 3. Causes:  Chronic parenchymal liver disease:  Chronic hepatitis:  Cirrhosis.  Fulminating hepatic failure:  Acute viral hepatitis  Drugs  Toxins e.g. Wilson’s Disease, CCL4, Surgical Portal-systemic anastomoses, portacaval shunts, or Transjugular intrahepatic portal-systemic shunting [TIPS]).
  4. 4. Factors precipitating hepatic encephalopathy:    Metabolic stress  Infection  Electrolyte imbalance, especially hypokalemia;  Dehydration , Renal failure  Diuretic drugs, Disorders that increase gut protein  GI bleeding  High-protein diet Nonspecific cerebral depressants  alcohol, sedatives, analgesics
  5. 5. PATHOPHYSIOLOGY
  6. 6. Clinical Features of hepatic encephalopathy: A Disturbance in consciousness  Disturbances in sleep rhythm.  Impaired memory/ apraxia  Mental confusion.  Apathy.  Drowsiness / Somnolence  Coma.
  7. 7. B. Changes Personality  Childish behavior.  May be aggressive out burst.  Euphoric.  Foetor hepaticus – Foul–smelling breath associated with liver disease due to mercaptans
  8. 8. C Neurological signs:  Flapping tremor / Asterixis (in pre coma).  Exaggerated tendon reflex.  Extensor plantar reflex.
  9. 9. Clinical stages of Hepatic Encephalopathy
  10. 10. Investigations Diagnosis is usually made clinically  No Pathognomonic liver function abnormality  Elevation of blood ammonia  Hypokalaemia  EEG (Electroencephalogram)  CSF & CT Scan – Normal  Other Routine Investigations TC, DC, ESR, Hb, Na, k, Urea, Creatinine, Prothrombin time
  11. 11. Differential Diagnosis  Subdural Haematoma  Drug or Alcohol intoxication  Wernicke’s encephalopathy  Hypoglycaemia
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