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HEPATIC ENCEPHALOPATHY


It is a neuropsyc├Čatric syn charactrisd by-distrbanc in consciousness n bhavior,personalty changes,fluctuatng neurologic signs,asterixis or fleping tremors,eeg changes.

Aetiology n pathogenesis

1-hep enc is due to biochemicl distusbanc f brain functn resultng 4m toxic substnc reachn brain

2-3factors operate which permit these toxic substnc to reach brain.

3-inc permeabitity of bbb alow toxin to enter brain
toxic substances-ammonia,gaba,mercaptans,short chain faty acids,octapamine,amino acids,phenol.
Precipitatn factors-git bleed,inc dietary protein,large volume paracentesis,hypokalemia n hyponatremia vomitin n diarrhoea overzealous use f diuretics acute infectn uremia sedativ constipatin viral hepatitis surgicl shunts.



C/f

1-distrbanc in conscious n bhavior-hyperosmia,reductn in spontaneous mov,confusion disorientn drowsines coma

2-personalty changes-childishnes,iritability n los f concern 4 family,defaecating n micturating

3-fluctuating neurologic signs-slurred speech,constructional apraxia,hypertonia,hypereflexia,bilateral extensor plantar respons

4-asterixis or fleppin tremors.
Investigations
blood amonia raisd,eeg shows delta waves ,csf-normal proteins inc glutamic acid inc glutamin normal cel count,visual evoked potential abnormalties,liver functions.

Rx-
rx or removal f pptn causes,maintain calories,correct electrolyte imbalanc,eliminat dietry proteins,ryle tube aspiratn n bowel wash to remove blood,oral neomycin 0.5g -1g 6hrly to sterlis gut,lactulose syrup 15-30ml 3times orally per day.Dose increasd gradualy til ther r 2-3 loose stools pr day,lactitol hs similar actn more palatable n beter dan lactulose,iv mannitol to reduce d sptaneoous cerebral oedema,haemoperfusn to remove toxic substnces,hepatic transplatn.




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