Question

hepatic encephalopathy

Answer 1

Definition:-

The loss of brain function when a damaged liver doesn't remove toxins from the blood.

Hepatic encephalopathy generally occurs in people with chronic liver disease, such as cirrhosis or hepatitis. Triggers include infection and dehydration.

Hepatic encephalopathy is characterized by personality changes, intellectual impairment, and a depressed level of consciousness

It occurs when, portal blood starts entering into systemic circulation directly, instead of going to vena cava. It occurs due to portosystemic shunt

Causes:-

starts when liver gets damaged from a disease having a long term effect like chronic hepatitis, Reye's syndrome, or cirrhosis.

Some other reasons include :-

Have an infection

Don't get enough to drink

Bleed from your intestines, stomach, or esophagus

Take certain medicines like some sleeping pills, pain relievers, or water pills

Having kidney problems

on an alcohol binge.

Pathogenesis:-

In general when NH3 is produced after protein metabolism in intestine, it is engaged in urea cycle in liver, and body is made free of it,

But in hepatic encephalopathy :-

NH3 produced in intestine

Enters systemic circulation and reaches brain

In brain, specifically Astrocytes (glutamate) combines with NH3 and glutamine is formed

Glutamine enters neurons, and start acting on NMDA receptors

Leads to neurotoxicity

Causes:-

1) EC & CSF - glutamate is increased

2) Overall brain, glutamate is decreased

Signs and symptoms :-

Get confused

Forget things

sudden change in your personality or behavior

Speak or act inappropriately to others

Not feel interested in things

Decrease in physical abilities

Alkalosis

Types:-

It's basically of three types

Type A:- due to acute liver failure resulting in cerebral edema

Type B :- occuring post TIPSS (transjuglar intrahepatic portosystemic shunting)

Type C :- in cirrhosis & HTN (most common)

Diagnosis:-

EEG (electroencephalograph)

NH3 level in blood

Treatment:-

Lactulose (with bowel wash, non absorbable disaacharide to reduce ph )

Rifaximin 400 mg (TDS)

Acarbose

L-ornithine & L-aspartate

Sodium Benzoate