4. Type A: Associated with acute liver failure.
Type B: Occurs when there is no primary liver damage
and encephalopathy occurs due to portosystemic shunting
of blood.
Type C: Associated with chronic liver disease such as
cirrhosis and portal hypertension. The encephalopathy can
either be episodic (acute) or persistent (chronic).
6. Grade Level of consciousness Intellectual function Neurologic function
0 Insomnia, sleep disturbance Change in computation skills Impaired handwriting
1 Lack of awareness, personality
change
Short attention span, mild
confusion, depression
Incoordination , asterixis
2 Lathergy, drowsiness,
inappropriate behaviour
Disoriented Astrexis, abnormal reflexes
3 Asleep, rousable Loss of meaningful
conversation, marked confusion,
incomprehensible speech
Asterixis, abnormal reflexes
4 Not rousable Absent Decerebrate
7.
8. Health history
Physical examination
Blood test
CSF analysis
CT/MRI of brain
Electroencephalogram
Hepatic function
9. Lactulose -Patients should take sufficient lactulose as to have
2-4 loose stool per day.
Oral magnesium sulphate or enemas are given after
haemorrhage to clean out the intestine.
Antibiotic:
- Neomycin; Initial dose is 250 mg orally 2-4 times a
day. Neomycin is usually reserved as a second line
treatment after initiation of treatment with lactulose.
- Rifaximin; dose of 400 mg taken orally 3 times a day
was effective as lactulose.
Hydroxyzine 25mg at bed time to improve quality of sleep.
10. Additional management:
Regular assessment of neurological function
Record fluid input and output
Vital monitoring daily 4hourly
Serum ammonia level monitored daily.
GI suction to reduce absorption of ammonia.
11. Liver transplantation surgery is indicated for chronic
or refractory hepatic encephalopathy.
12. 1.Ineffective breathing pattern related to hypoxia as
evidenced by lower respiratory rate.
2.Deficient fluid volume related to bleeding, decreased
intake as evidenced by physical examination.
4.Imbalanced nutrition: less than body requirement
related to diet restriction as evidenced by fatigue.
13. 5.Deficient knowledge related to disease process, it
control as evidenced by frequent questioning by the
patient and family members.
6.Ineffective individual coping related to stress imposed
by chronic illness
3.Risk for infection related to immune compromise
secondary to chronic illness.
