Hepatic Encephalopathy

Question 1

Leading hypothesis as to the cause of Hepatic Encephalopathy (HE).

Answer 1

1. Ammonia-glutamine toxicity due to ammonia bypassing the liver and avoiding metabolism in the urea cycle.

2. Upregulation of astrocytic peripheral 
benzodiazepine receptors (PBR)

3. Neurosteroid production
4. Modulation of GABAA receptor
5. Hepatic encephalopathy

Question 2

Describe the 3 types of HE.

Answer 2

Type A: caused by acute liver failure
Type B: caused by portosystemic bypass
Type C: cirrhosis and shunt, chronic

Question 3

Which grade of the Modified West Haven HE grading system do you require a liver transplant?

Answer 3

Grade 3 or Grade4
-if the patient reaches this stage it usually means that it’s Type A and progression occurs within hours. Grade 4 means pt is comatose

Question 4

Treatment for Minimal HE.

Answer 4

Lactulose or Synbiotics

-lowers ammonia levels in the blood

Question 5

2 symptoms that differentiate HE from alcohol withdrawal.

Answer 5

1. Hallunications

2. Diaphoresis: excessive sweating

Question 6

3 main treatments for HE.

Answer 6

1. Treat cause: infection, shunt, etc.
2. Lactulose: gut acidification restricts protein absorption
3. Suppress GI flora (antibiotics)