Question

62 year old male admitted into hospital with a history of colicky abdominal pain associated with increasing ascites and jaundice. liver function at this time was markedly abnormal with a bilirubin of 257, INR 2.4, Albumin 23.
Clinical signs were of hepatic encephalopathy with marked ascites. several litres of fluid were drained and a culture isolated pseudomonas sp. he was treated with antibiotics but continued to deteriorate and also developed renal failure due to hepatorenal syndrome. unfortunately, he died 6 days after admission.

What was patients cause of death?
what were the signs and symptoms?

Answer 1

As already mentioned in question it is case of Heaotorenal syndrome ( HRS)
Criteria for diagnosis of HRS:
1. Cirrhosis + Portal Hypertension + Renal failure
2.No response after 2 consecutive days of diuretic removal or Plasma volume expansion with albumin
3. No recent use of Nephrotoxic drugs
4. Absence of shock .
5. No macroscopic signs of structural kidney injury .

Cause of death In this pateint is Acute Liver failure
Best treatment is Liver transplantation

Hepatic encephalopathy :
Symotoms -
1.First prominent symptom -Altered sleep rhytm
2.Decreased awareness of environment
3. Slurred speech
4.Emotional lability
5. Depression
6 .Somnolescemce and obtundation

Signs -
1. First prominent sign - Psychometric test
2. First prominent finding is Tremors
3. Asterixis in early stages can be elicited by having patients extend their arms and bend their wrists back. In this maneuver, patients who are encephalopathic have a “liver flap”—that is, a sudden forward movement of the wrist .
4. Stupor and coma in late stages

Treatment of hepatic encephalopayhy -
1. Lactulose
2. Rifaximin 550 mg Bd
3. LoLA( L ornitnine L aspartate )
4. Acarbose
5.. Benzoate