Hepatic Encephalopathy, Hyperammonemia, and Current Treatment

Posted by e-Medical PPT Tuesday, September 21, 2010
Hepatic encephalopathy (portosystemic encephalopathy) is the occurrence of confusion, altered level of consciousness and coma as a result of liver failure.It is caused by accumulation in the bloodstream of toxic substances that are normally removed by the liver.The diagnosis of hepatic encephalopathy requires the presence of impaired liver function and the exclusion of an alternative explanation for the symptoms.Ammonia levels may be elevated.It is often precipitated by an intercurrent problem, such as infection or constipation.
The mildest form of hepatic encephalopathy is difficult to detect clinically.It is experienced as forgetfulness, mild confusion and irritability. More severe encephalopathy is characterised by an inverted sleep-wake pattern, marked irritability, tremor, difficulties with coordination and trouble writing.More severe forms of hepatic encephalopathy lead to a worsening level of consciousness, from lethargy to somnolence and eventually coma. In the intermediate stages, a characteristic jerking movement of the limbs is observed (asterixis,flapping tremor).
Encephalopathy often occurs together with other symptoms and signs of liver failure. These may include jaundice , ascites , and peripheral oedema .The tendon reflexes may be exaggerated, and the plantar reflex may be abnormal,(Babinski's sign) in severe encephalopathy. A particular smell (foetor hepaticus) may be detected.
Hepatic encephalopathy is reversible with treatment. This relies on suppressing the production of the toxic substances in the intestine and is most commonly done with the laxative lactulose or with non-absorbable antibiotics. In particular settings, such as acute liver failure, the onset of encephalopathy may indicate the need for a liver transplant.

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