Clinical Spectrum of Precipitating Factors of Hepatic Encephalopathy in Cirrhosis of the Liver (original) (raw)

Background and Objectives: Hepatic encephalopathy is an extra hepatic complication of impaired liver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. This study aims to ascertain the spectrum of precipitating factors of hepatic encephalopathy in patients with cirrhosis of the liver. Methods: 100 cases of cirrhosis of the liver who presented in hepatic encephalopathy admitted to Sri Venkateswara Ramnarain Ruia Government General Hospital(SVRRGGH) ,Tirupati between may 2017 and april 2018 were studied. All patients of more than 18 years of age, manifesting with signs of hepatic encephalopathy were included, and those who had acute fulminant hepatitis or non cirrhotic portal hypertension were excluded from the study. Detailed history, clinical examination and thorough investigations were done to look for any precipitating factor and the findings were recorded on a proforma and prognostic stratification through Child-Pugh score was done. Results: Out of 100 patients, Upper GI bleed (51%), Constipation (41%), Electrolyte imbalance (38%) and Infection (22%) stood out as the most common precipitating factors. Usage of diuretics, sedatives, and excess dietary protein were the other factors. Most patients were in grade III (30%) and grade IV (37%) of hepatic encephalopathy. Other common associations were Child Pugh class C (67%), mortality (37%), and Alcoholism (54%). Interpretation and Conclusion: Upper GI bleed, Constipation, Infection, and Electrolyte imbalance were the most common precipitating factors of Hepatic encephalopathy in this study.

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