Hepatic Encephalopathy

Hepatic Encephalopathy: Test and Diagnosis

1st order laboratory parameters – obligatory laboratory tests. Ammonia – liver detoxification performance parameter [ammonia ↑] Small blood count Inflammatory parameter – CRP (C-reactive protein) Electrolytes – calcium, chloride, potassium, magnesium, sodium, phosphate. Blood gas analysis (BGA) with lactate determination. Serum globulins Serum albumin – important protein (protein) [albumin ↓, as a sign of liver … Hepatic Encephalopathy: Test and Diagnosis

Hepatic Encephalopathy: Drug Therapy

Therapeutic targets Reduction of ammonia attack Symptomatic therapy, depending on severity. Therapy recommendations Elimination of triggering factors: For gastrointestinal bleeding (bleeding in the gastrointestinal tract): hemostasis and bowel cleansing, and prophylactic antibiotic administration. Hydration in case of exsiccosis (dehydration). Discontinuation of diuretics (dehydrating drugs), sedatives (tranquilizers). Possibly short-term administration of benzodiazepine antagonists (flumazenil) for after-effects … Hepatic Encephalopathy: Drug Therapy

Hepatic Encephalopathy: Diagnostic Tests

Obligatory medical device diagnostics. Abdominal ultrasonography (ultrasound examination of the abdominal organs) – for basic diagnosis. Computed psychometry – gold standard; very time consuming compared to flicker frequency. Flicker frequency analysis Very accurate form of diagnosis with high sensitivity There is a correlation between the critical flicker frequency and the severity of hepatic encephalopathy: the … Hepatic Encephalopathy: Diagnostic Tests

Hepatic Encephalopathy: Prevention

To prevent hepatic encephalopathy (HE), attention must be paid to reducing individual risk factors. Behavioral risk factors Diet High protein (protein-rich) diet Consumption of stimulants Alcohol (woman: > 40 g/day; man: > 60 g/day). Drug use Ecstasy (also XTC and others) – collective name for a variety of phenylethylamines. Cocaine Drugs Laxatives (laxatives) Sedatives (tranquilizers)

Hepatic Encephalopathy: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate hepatic encephalopathy (HE): Persistent fatigue Apathy (lack of passion) Limited performance Insomnia (sleep disturbances) Concentration disorders Rapid fatigability Sleepiness Mood swings Tremor (trembling of the hands) – “flapping tremor”. Change in writing – Even in the early stages, stage 0 (see under “Classification”), the writing becomes “spidery”. Decreased … Hepatic Encephalopathy: Symptoms, Complaints, Signs

Hepatic Encephalopathy: Causes

Pathogenesis (disease development) Hepatic encephalopathy (HE) is a relatively common complication of liver cirrhosis (liver shrinkage). Impaired liver function results in inadequate detoxification of neurotoxic substances (substances toxic to the nervous system) such as ammonia, endogenous benzodiazepines, short-chain fatty acids, gamma-aminobutyric acid (GABA), mercaptan (responsible for the smell of raw liver (“foetor hepaticus”)), phenols, and … Hepatic Encephalopathy: Causes

Hepatic Encephalopathy: Therapy

General measures Alcohol abstinence (complete abstinence from alcohol). Nicotine restriction (abstaining from tobacco use) – smoking promotes fibrosis of the liver. Review of permanent medication due topossible effect on the existing disease. Vaccinations The following vaccinations are advised, as infection can often lead to worsening of the present disease: Flu vaccination Hepatitis A vaccination Hepatitis … Hepatic Encephalopathy: Therapy

Hepatic Encephalopathy: Medical History

Medical history (history of illness) represents an important component in the diagnosis of hepatic encephalopathy (HE). Family history Is there a history of frequent liver disease in your family? Social history Current medical history/systemic history (somatic and psychological complaints). What symptoms have you noticed? How long have these changes been present? Do you often feel … Hepatic Encephalopathy: Medical History

Hepatic Encephalopathy: Or something else? Differential Diagnosis

Endocrine, nutritional, and metabolic diseases (E00-E90). Diabetic ketoacidosis – form of metabolic acidosis that is particularly common as a complication of diabetes mellitus in the presence of absolute insulin deficiency; causative is an excessive concentration of ketone bodies in the blood. Wernicke’s encephalopathy (synonyms: Wernicke-Korsakow syndrome; Wernicke’s encephalopathy) – degenerative encephaloneuropathic disease of the brain … Hepatic Encephalopathy: Or something else? Differential Diagnosis

Hepatic Encephalopathy: Classification

Based on the “West Haven criteria,” hepatic encephalopathy (HE) is classified into the following stages: Stage Description Psychometric test procedures* 0 (minimum HE) Asymptomatic; no clinical neurological symptoms, but deficits in cognitive subdomains such as attention, fine motor skills, short-term memory, visuospatial perception pathological (pathological) I Onset of drowsiness, poor concentration, sleep disturbances, mood swings, … Hepatic Encephalopathy: Classification