hepatic encephalopathy
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
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