Hepatic encephalopathy1234567899 _1.pptx

About hepatic encephalopathy

1. Hepatic Encephalopathy Presenter: Bindi A M Moderator : Dr. Amit Kamath Sir

2. Hepatic Encephalopathy Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver disease that progresses from confusion to coma.

3. Pathogenesis Gut derived neurotoxins that are normally metabolised by the liver. Brain water homeostasis. Oxidative / nitrosative stress. Astrocyte dysregulation. Neurotransmitter dysfunction. Infection and inflammation.

4. Vascular Shunting Decreased liver mass. Increased permeability of the blood brain barrier.

5. NH3 Increasing Factors Dietary protein load Constipation GI hemorrhage Sepsis Blood transfusion Alkalosis Hypokalemia Hypovolemia Hyponatremia Dehydration TIPSS SEDATIVES UREMIA Precipitating Factors

6. Types of Hepatic encephalopathy

7. ●A flapping tremor (asterixis). ●Inability to perform simple mentalarithmetic.●Inability to draw objects such as a star (constructionalapraxia). ●Hyper-reflexia. ●Bilateral extensor plantar responses. An EEG shows diffuse slowing of the normal alpha waves with eventual development of delta waves. Examination usually shows:

8. Investigations

9. Blood Ammonia levels Electroencephalography CSF analysis Routine LFTs Imaging

10. Management

11. The principles are to treat or remove precipitating causes and to suppress production of neurotoxins by bacteria in the bowel . Lactulose (15–30 mL 3 times daily) is a disaccharide that is taken orally and produces an osmotic laxative effect. It reduces the colonic pH, thereby limiting colonic ammonia absorption, and promotes the incorporation of nitrogen into bacteria. Rifaximin (400 mg 3 times daily) is a non-absorbed antibiotic that acts by reducing the bacterial content of the bowel . Dietary protein restriction is no longer recommended and can lead to worsening nutritional state in already malnourished patients.