hepatic encephalopathy

Question 1

what is excessively absorbed in hepatic encephalopathy

Answer 1

ammonia + glutamine
is excessively absorbed from bacterial breakdown of proteins in gut

Question 2

clinical features of hepatic encephalopathy

Answer 2

confusion, altered GCS
asterixis = liver flap, myoclonus

constructional apraxia = inability to draw a 5 pointed start

triphasic slow waves on EEG
raised ammonia

Question 3

precipitating factors to hepatic encephalopathy

Answer 3

infection - SBP
GI bleed
post transjugular intrahepatic portosystemic shunt
constipation
drugs - sedative, diuretics
hypokalaemia
renal failure
increased dietary protein

Question 4

hepatic encephalopathy management

Answer 4

1st line = lactulose with addition of rifaximin for 2nd prophylaxis

treat underlying precipitater

Question 5

MoA of lactulose in mx of hepatic encephalopathy

Answer 5

promotes excretion of ammonia + increasing metabolism of ammonia by gut bacteria

Question 6

MoA of antibiotics such as rifaximin in mx of hepatic encephalopathy

Answer 6

modulates gut glora resulting in decreased ammonia production