Hepatic Encephalopathy Flashcards
1
Q
Mechanism of hepatic encephalopathy
A
thought to be due to excess absorption of ammonia and glutamine from breakdown of proteins in the gut.
2
Q
Clinical features of hepatic encephalopathy
A
- confusion
- altered GCS
- ‘liver flap’
- constructional apraxia: inability to draw a 5-pointed star
- raised ammonia level
3
Q
Grading of hepatic encephalopathy
A
Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma
4
Q
Factors precipitating hepatic encephalopathy
A
- infection e.g. spontaneous bacterial peritonitis
- GI bleed
- post TIPPS
- constipation
- drugs: sedatives, diuretics,
hypokalaemia - renal failure
5
Q
Management of hepatic encephalopathy
A
1st Line = lactulose
Add rifaximin for secondary prophylaxis
OTHER:
embolisation of portosystemic shunts
liver transplantation in selected patients
6
Q
How does lactulose work to treat hepatic encephalopathy
A
promotes metabolism/excretion of ammonia
7
Q
How does rifaximin work
A
modulates the gut flora resulting in decreased ammonia production
