hepatic encephalopathy Flashcards

1
Q

What is hepatic encephalopathy?

A

Hepatic encephalopathy is brain dysfunction caused by advanced liver insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes and risk factors for this:

A
  • Cirrhosis
  • liver cancer
  • Hepatitis,
  • Intestinal Bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathophysiology of hepatic encephalopathy

A

Decreased Liver function → build up of toxic metabolites (NH3) → Astrocyte ion channels activated, increased production of cytokines and stimulation of osmotic pumps → swelling of astrocytes → contributes to cerebral oedema =
NEUROLOGICAL CHANGES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Presentation of hepatic encephalopathy?

A

Mood Disturbances – Depression Sleep Disturbances – Insomnia
Motor Disturbances – Ataxia, Muscle Rigidity, Bradykinesia
Confusion
Liver Symptoms too – ascites, jaundice, peripheral oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnosis and investigations

A

FBC and Basal Metabolic Panel
Blood Alcohol
Blood ammonia – raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

1st line treatment

A

1st Line: Lactulose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2nd line treatment

A

Rifaximin – reduces number of ammonia producing intestinal bacteria
Liver transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Complications of hepatic encephalopathy

A

Cerebral Oedema
Aspiration Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is it caused by

A

build up of toxins that affect the brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which toxin predominantly affects the brain in HE?

A

Ammonia - produced by intestinal bacteria when they break down proteins and is absorbed in the gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

2 reasons ammonia builds up in blood in patients with cirrhosis

A
  1. functional impairment of the liver cells prevents them metabolising the ammonia into harmless waste products.
  2. collateral vessels between the portal and systemic circulation mean that the ammonia bypasses liver altogether and enters the systemic system directly.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we manage HE?

A

Laxatives (i.e. lactulose) promote the excretion of ammonia. The aim is 2-3 soft motions daily. They may require enemas initially. help clear the ammonia from the gut before it is absorbed and by giving antibiotics we reduce the number of bacteria in the gut producing ammonia.

Antibiotics (i.e. rifaximin) reduces the number of intestinal bacteria producing ammonia. Rifaximin is useful as it is poorly absorbed and so stays in the GI tract.

Nutritional support. They may need nasogastric feeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Precipitating factors

A

Constipation
Electrolyte disturbance
Infection
GI bleed
High protein diet
Medications (particularly sedative medications)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly