Hepatic Encephalopathy

Question 1

What is hepatic encephalopathy?

Answer 1

Neuropsychiatric manifestation of liver disease
Ammonia is normally converted into urea by liver and excreted by kidneys
Liver unable to convert albumin to urea. ⬆️ammonia lvls in circulation
Ammonia crosses the blood brain barrier and produces neurological toxins

Question 2

Clinical manifestations of Hepatic Encephalopathy

Answer 2

• Asterixis (liver flaps)
• Slow slurred speech
• 1st Hyperventilation & 2nd Deep slow RR
• Yawning & Drowsiness: altered sleep patterns
• Confusion - Apathy - depression
• Hyperactive reflexes

Question 3

Nutritional management of Hepatic Encephalopathy

Answer 3

⬆️ Carbs
⬇️ Protein
⬇️ Fat
⬇️ Sodium

Question 4

Pharmacological management of Hepatic Encephalopathy

Answer 4

• Lactulose: ⬇️pH in GI (GI 7.5 pH) which kills bacteria & pulls ammonia which leads to diarrhea = ⬇️ ammonia levels
• Neomycin : Sterilize GI
• Rifaximin, Vancomycin, Metronidazole ( also sterilize GI)