Hepatic Encephalopathy

Question 1

What is hepatic encephalopathy?

Answer 1

Decline in brain function due to liver disease

Question 2

What is the pathophysiology of hepatic encephalopathy?

Answer 2

Nitrogenous waste products build up in circulation and cross the BBB

Broken down by astrocytes to glutamine

Glutamine causes an osmotic imbalance so fluid moves into brain

Question 3

What are the features of hepatic encephalopathy?

Answer 3

Confusion
Asterix = liver flap
Altered GCS

Question 4

What are the stages of hepatic encephalopathy?

Answer 4

Grade 1 = altered mood/behaviour

Grade 2 = confusion, increasing drowsiness

Grade 3 = Incorherent, restlessness

Grade 4 = coma

Question 5

What can precipitate hepatic encephalopathy?

Answer 5

Infection 
GI bleed 
Constipation 
Renal failure 
Hypokalaemia 

Drugs

• sedatives
• diuretics

Question 6

How is hepatic encephalopathy managed?

Answer 6

Treat underlying cause

1s line = lactulose + rifaximin

Question 7

How does lactulose work in hepatic encephalopathy?

Answer 7

Promotes excretion of ammonia

Increases metabolism of ammonia by gut bacteria

Question 8

How does rifaximin work in hepatic encephalopathy?

Answer 8

Modulates gut flora - reduces ammonia production