Hepatic Encephalopathy

Question 1

1. A liver disease which has a complex neuropsychiatric syndrome.
2. This is also known as?
3. Pathogenesis
4. Clinical Manifestations

Answer 1

1. Hepatic Encephalopathy
2. Porto Systemic Encephalopathy
3. Due to increased levels of ammonia and inflammation
4. *Insidious Onset
   *Mild Changes in ability to concentrate and complete complex task
   *Mental Status Changes

Question 2

T or F
1. Hepatic Encephalopathy is potentially reversible
2. This condition can occur only in chronic liver disease.

Answer 2

1. True
2. False: both acute and chronic

Question 3

*Nearly asymptomatic
*Normal Level of Conciousness
*No detectable personality or behavioral changes
*Minimal Chanes in memory and concentration
*Minimial Changes in intellectual Function

Answer 3

Grade 0 of HE

Question 4

• Slight personality changes, mood swings
• Short attention span
• Mild Confusion
  *Bilateral Numbness/tingling
  *Muscular Incoordination
  *Apraxia
  *Tremor:asterixis may be observed with clinical testing
  *Impaired Handwriting
  *Sleep disorders (inverted sleep patters)

Answer 4

Grade 1 of HE

Question 5

• Tremor progresses to asterixis
• Resistance to passive movement
• Myoclonus (Hypoactive deep tendon reflexes)
• Lethargy or apathy
• Unusual behaviour (abusive, violent, noisy)
• Apraxia
• Ataxia
• Slow or slurred speech

Answer 5

Grade 2 of HE

Question 6

*Hyperventilation
*Marked confusion, amnesia
*Incoherent speech
*Asterixis
*Muscle Rigidity
*Positive Babinski Sign
*Sleeps most of the time but can be aroused
*Disorientation to time and place
*Disinhibited (inappropriate) behavior

Answer 6

Grade 3 of HE

Question 7

• Comatose
• No asterixis
• Positive Oculocephalic (doll’s eye reflex)
• Decerebrate Posturing
• Dilated Pupils
• Lack of response stimuli

Answer 7

Grade 4 of HE