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 The Digestive SystemHepatic Encephalopathy - Cirrhosis Synonyms : Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs, Hepatic Encephalopathy is
a neuropsychiatric syndrome caused by liver disease. It
is due to disturbances of brain function caused by biochemical neurotoxins
accumulated in the blood which can’t be detoxicated by the damaged liver. Little is known of these neurotoxins causing encephalopathy, but they are thought to be nitrogenous substances produced mainly in the gut through protein decay, at least in part by bacterial action, which are normally metabolised by the healthy liver so that they don’t enter the systemic circulation. Possible candidates are ammonia, false neurotransmitter a-aminobutyric acid, octopamine and mercaptans. Clinical features: < BACK TO TOP >
Changes
in intellect, personality, emotions and consciousness are the main features.
There
is apathy, inability to concentrate, confusion, disorientation, drowsiness,
slurring of speech.
Muscle
tremor and inability to perform fine and precise movements and activities may
be observed; impairment of writing is characteristic and may be used in
assessing the extent and progression of the condition.
Coarse
flapping tremor of hands that can be elicited when the patient extends both
arms and flexes backwards both hands (action for ‘stopping traffic?. Hyperreflexia, convulsions and eventually coma develop. Diagnosis: < BACK TO TOP >
The
diagnosis can usually be made clinically in patients who have been suffering
from verified chronic liver disease for long time.
Electroencephalogram
(EEG) shows characteristic changes in the brain electrical activity. Other biochemical features characteristic for advanced liver damage are always present. Management < BACK TO TOP >
Episodes
of encephalopathy are common in cirrhosis
and are usually readily reversed until the terminal stages occur.
It is
important to treat or remove precipitating causes (e.g., alcoholic bout,
potentially hepatotoxic drugs like sedatives, antidepressants or hypnotics,
gastrointestinal bleeding, excess dietary protein, constipation,
infection).
Protein
intake should be eliminated or at least reduced below 20 g/day, carbohydrate
foods should be given instead such as fruit juices, jellies, hard lollies,
rice and cereals.
The
bowels should be cleansed with enemas; synthetic disaccharide lactulose [Duphalac,
Atilax] is taken orally in order to stimulate bowel movements and to
eliminate toxins produced by the bacteria. Neomycin [Neosulf] is a non-absorbable antibiotic which acts by reducing the bowel flora and hence production of toxins in the gut. Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP > Nutrition that alleviate or prevent Hepatic Encephalopathy :- Herbs < BACK TO TOP > Herbs that alleviate or prevent Hepatic Encephalopathy :- (source : -) |
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