Editing Hepatic encephalopathy

== Precipitating factors: (need to look carefully for what is driving it) ==




== Clinical findings: ==

** Asterixis (non-specific - also seen in other metabolic encephalopathies)
** Seizures rare
** Focal neurological deficits rare




== Diagnosis ==

** Exclude differential diagnoses
** Ammonia levels are commonly elevated, but doesn't correlate with severity, and does not add prognostic or diagnostic value - don't check it
** EEG always abnormal, but non-specific
**

== Grade severity: ==


== Treatment ==

** Lactulose
*** Increases ammonia clearance
*** Should improve symptoms within hours
*** Give at a dose sufficient to produce 2-3 soft bowel motions per day
** Antibiotics
*** Rifamixin has proven efficacy in setting of lactulose use - 550mg BD
*** Both treatment and prophylactic
** Polyethylene glycol
*** 4L orally/NGT
*** Improved faster than lactulose in acute encephalopathy
*** Not correlated with ammonia clearance rate
*** Unclear how it works
** Dietary protein management
** Hepatic encephalopathy in acute liver failure
*** Beware of cerebral oedema
**** 35% in grade 3, 75% in grade 4 encephalopathy
*** If patients with acute liver failure develop grade 2 encephalopathy, need ICU for monitoring and multiorgan support
*** Grade 3 - should be ventilated with head elevated to 30 degrees, consider mannitol/hypertonic saline

[[Category:Gastroenterology]]