Hepatic encephalopathy

Hepatic encephalopathy is due to rise in ammonia levels in blood

Etiopathogenesis :

  • Increased ammonia level in blood (Most important)
  • Increase in short chain fatty acids
  • Rise in methionine level
  • Rise in false neurotransmitters like octopamine
  • Increased conversion of tryptophan to inhibitory neurotransmitter serotonin
  • Increased sensitivity of CNS neurones to GABA (inhibitory neurotransmitter)
  • Increased conversion of tryptophan to inhibitory neurotransmitter serotonin
  • Ratio of aromatic amino acids (phenylalanine, tyrosine and tryptophan) to branched-chain
    amino acids (leucine, isoleucine and valine) is raised
  • Excessive manganese deposition in the basal ganglia
  • Increased circulating levels of endogenous benzodiazepines

2 main factors- Liver failure and shunting of portal blood into systemic circulation bypassing the liver.


Signs and symptoms :

  • Disturbed consciousness
  • Inversion of sleep rhythm
  • Slurred speech
  • Musty odour in breath (fetor hepaticus)
  • Personality changes (loss of family concern)
  • Intellectual deterioration
  • Flapping tremor in hands (asterixis)
  • Constructional apraxia – Inability to reproduce simple diagrams with blocks

Diagnosis:

1.blood ammonia levels
2.electroencephalogram
3.dot join test


Treatment:

1.Lactulose
2.adequate protein intake
3.oxygen therapy
4.iv fluids
5.Antibiotics

Mrunali Gondane

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