Hepatic Encephalopathy Flashcards
What is hepatic encephalopathy
Neuro-psychiatric disorder associated with liver failure
What is the pathophysiology of hepatic encephalopathy
Thought to be due to accumulation and build-up of neurotoxins which were normally detoxified by the liver
Eg. ammonia, mercaptane
What are some precipitants of hepatic encephalopathy
DIGS
Drugs - eg. diuretics
Infection - spontaneous bacterial peritonitis
GI bleeding
Surgery
Metabolic abnormalities - hypokalaemia
Constipation
Why does GI bleeding precipitate encephalopathy
Blood in GIT increases protein supply
Breakdown leads to increased ammonia and nitrogen absorption from gut
Why does constipation precipitate encephalopathy
Increases intestinal production and absorption of ammonia
What are the signs of hepatic encephalopathy
Drowsy
Hyperventilation
Asterixis
How is hepatic encephalopathy graded
West Haven Grades
What is West Haven Grade 1
Drowsy but coherent
Mood changes
Shortened attention span
Day-night reversal
What is West Haven Grade 2
Drowsy and confused at times
Inappropriate behaviour
Intermittent disorientation
What is West Haven Grade 3
Very drowsy but rousable Disorientated Alternatively restless and screming Marked confusion Incomprehensible speech
What is West Haven Grade 4
Comatose and barely rousable
What is a complication of Grade 3/4 hepatic encephalopathy
Cerebral oedema - patients with acute liver failure
Due to increased blood flow and loss of auto-regulation and astrocyte swelling
What can cerebral oedema in hepatic encephalopathy cause
Can lead to decerebrate posturing and dysconjugate eye movements
Can lead to brainstem coning and death
