Hepatic Encephalopathy By Charis Conradi Overview Name Epidemiology

Hepatic Encephalopathy By Charis Conradi

Overview • • • Name Epidemiology Classification Treatment Future Sources

What is HE Heaptic= Liver Encephalo = brain -pathy = disorder „spectrum of neuropsychiatric abnormalities in patients with liver dysfunction” • Blood test – ammonia concentration • •

Epiology • accumulation in the bloodstream of toxic substances • Excessive nitrogen load • Drugs and medications • Excessive alcohol consumption • Infections • portosystemic shunt surgery • Unknown 20 -30%

Liver functions Protein metabolsim Carbohydrate metabolism Fat metabolsim Bile production Vitamin storage Fibrinogen, prothrombin, factor VII (vitamin K dependent) • Excrition of Hormones and Drugs • • •

Epidemology Alcohol-attributable liver cirrhosis deaths per 100, 000 people in 2010 by global-burden-of-disease region

Causes • Liver failure – acute onset between 7 and 28 days – chronic • observed in nearly 70% of patients with cirrhosis • 24 -53% of patients who undergo portosystemic shunt surgery

from liver failure to brain damage • Nitrogen compounds portal vein urea cycle excreted by kidney • impaired due to damaged hepatocytes or due to portosystemic shunts (venous blood bypasses the liver) Nitrogenous waste products accumulate in the systemic circulation • ammonia (NH 3) blood brain barrier

NH 3 • Astrocytes : glutamine glutamate • Increased amount of glutamine Increased osmotic pressure brain edema

Stages - West Haven Criteria Grades State of consciousnes Intellectual function 1 Trivial lack of awareness Sleep disorder Shortened attention Euphoria or Asterixis span depression tremor 2 Lethargy „forgefulness“ Disorientation to time Amnesia of recent events 3 4 Personality behavior Inappropria te behavior Anxiety Neuromuscul ar disorders -Slurred speech -Hyperactive reflexes Somnolence Confusion Bizarre Babinski ( sleepiness) to Gross disorientation behavior relfex, rigidity stupor Coma (unresponsive to Unable to test verbal/noxious stimuli)

Treatment • Type 1 due to acute liver failure – Intubation – Transplantation • Type 2 (bypass) – Occlusion of bypass • Type 3 (infections) – Antibiotics

Perspective • Multiple causes • Vaccination • Less alcohole consumption

Sources • http: //www. nature. com/ajg/journal/v 104/n 6/fig_tab/ajg 2009160 t 1. html criteria • http: //emedicine. medscape. com/article/2054408 overview normal Nh 3 levels • Gython and Hall Textbook of physiology • http: //emedicine. medscape. com/article/186101 overview Medscape : Hepatic Encephalopathy • http: //www. medscape. com/viewarticle/813788 Medscape : Global Burden of Liver Disease Substantial • http: //pubs. niaaa. nih. gov/publications/arcr 352/174183. htm

• https: //www. google. com/search? q=Babinski+sign&biw=1525&bih= 702&tbm=isch&imgil=Kbb. J 6 hhg. Vjv. AM%253 A%253 BU 5 Cb. Bk. WDt. QQ 5 EM%253 Bhttp%25253 A%25252 F%25252 Fmedchrome. com%25252 Fbasicscience%25252 Fanatomy%25252 Flesions-of-upper-motor-neuronsand-lower-motorneurons%25252 F&source=iu&pf=m&fir=Kbb. J 6 hhg. Vjv. AM%253 A%252 CU 5 Cb. Bk. WDt. QQ 5 EM%252 C_&dpr=0. 9&usg=__Qd w. YOGPcu 6 v 24 fh 4 E 2 u. CHSCvo 0%3 D&ved=0 CEAQyjdq. FQo. TCKueqc 7 vycg. CFYxx. FAod. DHk. E Eg&ei=BXAi. Vuu. HCIzj. UYzyk. ZAB#imgrc=n. C 7 v. HK 11 te. Zqo. M%3 A&usg= __Qdw. YOGPcu 6 v 24 fh 4 E 2 -u. CHSCvo 0%3 D ( babinski relfex) • https: //en. wikipedia. org/wiki/Hepatic_encephalopathy