Hepatic encephalopathy presentation latest aspect

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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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