Also known as Portosystemic Encephalopathy
ABOUT THE DISEASE
Hepatic encephalopathy (HE), is a neuropsychiatric syndrome followed by the occurrence of confusion, altered level of consciousness, and coma as a result of liver failure.It most often results from high gut protein or acute metabolic stress(electrolyte abnormality). In the advanced stages it is called hepatic coma or coma hepaticum. It may ultimately lead to death.
SYMPTOMS
The mildest form of hepatic encephalopathy is difficult to detect clinically. Symptoms are those of impaired brain function, especially reduced alertness and confusion.
Early Symptoms:- • Breath with a musty or sweet odor
- • Change in sleep patterns
- • Changes in thinking
- • Confusion that is mild
- • Forgetfulness
- • Mental fogginess
- • Personality or mood changes
- • Poor concentration
- • Poor judgment
- • Worsening of handwriting or loss of other small hand movements
Severe Symptoms:- • Abnormal movements/shaking of hands or arms
- • Agitation, excitement or seizures
- • Disorientation
- • Drowsiness/confusion
- • Strange behavior/severe personality changes
- • Slurred speech
- • Slowed or sluggish movement
Eventually, as liver function continues to deteriorate, they may lose consciousness and lapse into a coma. Coma often leads to death, despite treatment.
CAUSES
It is caused by accumulation of toxic substances in the bloodstream that are normally removed by the liver:
• Conditions that reduce liver function (such as cirrhosis or hepatitis).
• Conditions in which blood circulation does not enter the liver.
DIAGNOSIS
- Clinical evaluation
- Mental status testing.
- Blood tests
- Electroencephalography
TREATMENT METHODS
Treatment is aimed at elimination of triggers and toxic substances from intestine, with measures like:
Antibiotics-eg.Rifaximin, Neomycin
Bowel cleansing - through oral lactulose or enema
Protein intake-restricted to vegetable sources.
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Liver/Hepatic failure
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Encephalopathy
Cirrhosis
Hepatitis