Hepatic Encephalopathy

Question 1

Hepatic Encephalopathy
Synonyms

Answer 1

Porto systemic encephalopathy

Question 2

Precipitating Factor for Hepatic Encephalopathy
⚡⚡ MOST COMMON Cause
⚡⚡ 2nd MOST COMMON Cause
⚡⚡ Reversible Cause

Answer 2

⚡⚡ MOST COMMON Cause
🎯 GI Bleeds (DUE TO: Varices)
⚡⚡ 2nd MOST COMMON Cause
🎯 Constipation (Patient’s urea get absorbed)
⚡⚡ Reversible Cause
🎯 Protein Rich Diet

🎯 INFECTION / SEPSIS
🎯 RENAL FAILURE
🎯 ELECTROLYTE ABNORMALITIES
✨ Hyponatremia
✨ Hypokalemia
✨ Metabolic Alkalosis
🎯 Dehydration
🎯 Drugs: Opiates

Question 3

⚡⚡ MOST COMMON Toxin causing HEPATIC ENCEPHALOPATHY

Answer 3

Ammonia (NH3)

Question 4

Cells affected in Hepatic Encephalopathy

Answer 4

Astrocytes
⬇️ develop into
Alzheimer’s Type 2 Astrocytes

Question 5

Grading System used for a hepatic Encephalopathy

⚡⚡ MOST Accurate

Answer 5

1. West Haven Grading
2. FOUR (Full OUtline of Responsiveness)
   ⚡⚡ MOST Accurate

Question 6

Pathogenesis of Hepatic Encephalopathy

Answer 6

Question 7

Other toxins involved in Hepatic Encephalopathy

Answer 7

1. Merceptans
2. Phenols
3. FFA
4. GABA
5. Octapamine
6. Aromatic AA
7. Manganese

Question 8

Types of Hepatic Encephalopathy
🧠⚡ A for A, C for C⚡

Answer 8

Question 9

⚡⚡ MOST COMMON Hepatic Encephalopathy
🧠⚡ Commomest⚡

Answer 9

Type C

Question 10

Modified WEST HAVEN Criteria

Answer 10

Question 11

NORMAL Serum Ammonia rules out

Answer 11

Hepatic Encephalopathy

Question 12

New DIAGNOSTIC MARKER OF HEPATIC ENCEPHALOPATHY

Answer 12

3-Nitrotyrosine

Question 13

Clinical test for DIAGNOSIS🚦 of HEPATIC ENCEPHALOPATHY

Answer 13

Constructional Apraxia Test (Reitan Number Connection Test)

Question 14

TRIPHASIC WAVES IN EEG IN COMA Patient indicates

Answer 14

HEPATIC ENCEPHALOPATHY

Question 15

💊💉 MANAGEMENT of HEPATIC ENCEPHALOPATHY

Answer 15

1. Correct precipitating Factor
2. Lactulose Bowel Wash
3. Rifaximin Gut Sterilization
4. Low Protein Diet

Question 16

Role of Lactulose in Hepatic Encephalopathy

Answer 16

Makes the environment ACIDIC
⬇️
Converts Ammonia to NH+ excreted into stools

Question 17

Never make to patient to go into stage of Diarrhea in Lactulose therapy
Why?

Answer 17

Goes to Hypovolemia
⬇️
Again precipitates HEPATIC ENCEPHALOPATHY

Question 18

Lactulose therapy
Targets

Answer 18

🎯 2-4 loose stools
🎯 Dose: 30-40 ml (max: 90ml/day)

Question 19

LOLA
Mechanism of Action

Answer 19

L-Ornithine L-Aspartate
⬇️
Accelerate UREA CYCLE
⬇️
Ammonia utilisation ⬆️

Question 20

Newer therapies for HEPATIC ENCEPHALOPATHY

Answer 20

1. LOLA
2. BCAA infusion
3. Flumazenil
4. Zinc
5. Melatonin
6. Memantine
7. L-carnitone
8. Sodium Benzoate

Question 21

Dose of Rifaximin

Answer 21

400 mg TDS
(OR)
550 mg BD