Hepatic Encephalopathy: Causes, Classifications And Symptoms

Hepatic encephalopathy is extremely serious when it leads to changes in a person's behavior, mental state and nervous system, the most dangerous being a coma and death.
What is hepatic encephalopathy?
Hepatic encephalopathy or hepatic coma is a disorder of consciousness, behavior, and coma caused by hepatic dysfunction. The disease is caused by metabolic disorders of the central nervous system due to toxins that are not metabolized and eliminated by the liver because of impaired liver function. Hepatic encephalopathy is also a sign that the liver is weakening too badly.
Causes of hepatic encephalopathy
The cause of hepatic encephalopathy is divided into exogenous and endogenous

.
Exogenous causes
Patients on long-term intravenous feeding eat too much protein or too much infusion
Severe gastrointestinal bleeding
Using strong diuretics causes dehydration and hypokalemia.
Use hepatotoxic drugs: tetracycline, anti-tuberculosis drugs, sedatives, hypnotics, antihypertensive drugs, nonsteroidal anti-inflammatory drugs
Alcohol poisoning
Patients with cirrhosis after surgery
Infections of the liver, bile, kidneys, lungs, intestines.
Extraction of ascites: due to too many times or too many times reduce the amount of blood circulating through the liver
Endogenous causes
Conditions such as fulminant hepatitis, toxic hepatitis, liver cancer or end-stage cirrhosis cause severe and widespread liver damage
Hepatitis (hepatitis B, hepatitis C), autoimmune hepatitis or Reye's syndrome destroys liver cells
Patients with cirrhosis also use sedatives, analgesics
With severe hepatic impairment or by a portal stenosis, the blood is not metabolized by the liver cells from the portal to the liver, gradually becoming toxins that disrupt the metabolism of brain tissue.




Liver diseases can lead to hepatic encephalopathy
Subjects at high risk for hepatic encephalopathy
In addition to the causes of hepatic encephalopathy, the following subjects are at high risk for the disease:
People lose water, electrolyte imbalance
Eat too much protein, protein
Gastrointestinal bleeding
Liver infection
Renal pathology
There is hypoxemia
Use central nervous system inhibitors (such as barbiturates or benzodiazepine tranquilizers)
People with cirrhosis
Classification and symptoms of hepatic encephalopathy
According to the West Haven classification system, hepatic encephalopathy is divided into 5 stages corresponding to the specific symptoms as follows:
Phase 0
- Personality and behavior do not change significantly
- Mild mental distraction
State 1
- Personality changing, irritable
- The ability to think, concentration and intelligence is reduced, confusing slightly
- Shaky appearance
Phase 2
- Personality changes
- Disorientation in time, slow, great difficulty in thinking
- Trembling symptoms more clearly, easily exhausted
Phase 3
- Frequent drowsiness (but easy to wake up)
- Can not work minds, lost orientation of space and time
Phase 4
- In a coma
- Inability to exercise
- Can not work brain
Coma is the final stage of hepatic encephalopathy
Diagnosis of hepatic encephalopathy
Implementing the quadrants
The definitive diagnosis is made based on the symptoms of the disease:
Trembling
Committing incomplete behavior
Disordered sleep
NH3 increases
There is known liver disease
Differential diagnosis
Metabolic encephalopathy: diabetes mellitus (hypoglycemia, ketoacidosis), hypoxemia
Hepatic encephalopathy due to drug poisoning, alcohol intoxication
Hepatic encephalopathy due to neurological infection, trauma and stroke
Is hepatic encephalopathy treatable?
Decreased production and absorption of ammonia in the intestine
Diets reduced protein, supplemented with branched amino acids
Drugs: Lactulose, antibiotics
Increase ammonia elimination
Use drugs that increase the elimination of ammonia through the kidneys: arginine and ornithine, sodium benzoate.
Adjust risk factors
Dehydration, reducing circulating volume
Gastrointestinal bleeding: resolving bleeding by blood transfusion, support
Diarrhea, vomiting: rehydration, electrolytes
Suction large fluid: rehydration, electrolytes
Medicine
Diuretics lose a lot of potassium: potassium compensation, stop diuretics
Stop sedatives, depressants
Build a diet low in protein and high in fiber.

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