Hepatic encephalopathy in liver cirrhosis (original) (raw)
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Hepatic Encephalopathy in Liver Cirrhosis: Precipitating factor and Outcome
Journal of Nepalgunj Medical College, 2019
Introduction: Hepatic encephalopathy, one of the major decompensating events of liver cirrhosis manifest as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma. The main aim of this study was to determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Methods: A hospital based cross-sectional study carried out in the Department of Medicine, Nepalgunj Medical College, Kohalpur from September 2018 to May 2019. Patients of liver cirrhosis with signs and symptoms of hepatic encephalopathy (HE) were enrolled in the study. Detailed history was taken with patients or patient's visitor regarding precipitating factors. Child Turcotte Pugh (CTP) class was used for assessing liver disease severity and West Haven classification was used for grading of hepatic encephalopathy. Results: Total patients of hepatic encephalopathy studied were 150. Among which, 114 (76%) were male and 36 (24%) were ...
Clinical Spectrum of Precipitating Factors of Hepatic Encephalopathy in Cirrhosis of the Liver
IOSR Journals , 2019
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.
2017
Objective: To determine the frequency of precipitating factors of Hepatic Encephalopathy in Patients with Cirrhosis of Liver based on Child class. Study Design: Descriptive study. Setup: Medical Unit of Fauji Foundation Hospital (FFH) Rawalpindi. Duration of study: Duration of study was 06 months after the approval of synopsis i.e 1st November, 2010 to 31st April, 2011. Methods: Patients with Cirrhosis of liver who were aged 13 years or above; of either gender with signs and symptoms of hepatic encephalopathy were enrolled in the study. Precipitating factors were determined by detailed history, examination and laboratory investigations. Patients presenting with fever were evaluated through detailed systemic examination, blood complete picture for leucocytosis, ascitic fluid routine examination in patients with ascites. Cirrhotic patients were classified into Group A, B and C according to Child Pugh classification. Results: Out of 148 patients, 129 (87.16%) were females. Hepatitis C ...
2017
Cirrhosis of liver is a common chronic clinical entity. Hepatic encephalopathy is one of its frequent complication. Often there is an underlying precipitating factor which leads on to encephalopathy. Identifying and managing these factors will improve the quality of life of such patients. Aim: To study patients admitted with hepatic encephalopathy secondary to cirrhosis of liver and to evaluate for the known precipitants. Material and methods: Over a period of one and half year various factors precipitating hepatic encephalopathy in 50 patients with liver cirrhosis were evaluated. Patients were verified for fulfilling inclusion criteria and ruled out for presence of exclusion criteria. Grading of hepatic encephalopathy was done by West Haven Classification and prognostic stratification through Child Pugh score. Results: Gastrointestinal bleed as a precipitant of hepatic encephalopathy was noted among 60% of patients. Other precipitants include constipation, binge alcohol intake, ele...
Pathophysiological changes associated with increasing grade of hepatic encephalopathy
Journal of the National Medical Association, 1988
The pathophysiological changes occurring with increasing grade of encephalopathy were examined in 93 consecutive episodes in 44 patients with liver cirrhosis (37 posthepatic). The incidence of gastrointestinal bleeding and leukocytosis increased significantly when the grade advanced from 1 to 5. The following variables showed a trend for change that did not reach statistical significance: rising serum bilirubin, SGOT, and BUN levels; decreasing serum sodium and chloride levels; and increased incidence of infection. The mean values of the following variables were significantly different in 25 fatal episodes and 68 survivors, implicating a bad prognosis: high serum bilirubin, alkaline phosphatase, and BUN levels; low serum albumin, sodium, and chloride levels; and a higher incidence of severe infections (sepsis, infected ascitic fluid). Because increasing grade of encephalopathy is the most important factor in determining the prognosis of hepatic encephalopathy (mortality 0, 10, 5, 19...
The Professional Medical Journal
Introduction: Hepatic encephalopathy is a common complication of cirrhosis.Its development heralds a poor prognosis. Hepatic encephalopathy is often precipitated by an identifiable factor. Promptdiagnosis of precipitating factors is the key to management of this reversible complication of cirrhosis. Objective: Todetermine the frequency of precipitating factors for hepatic encephalopathy in patients diagnosed with cirrhosis. StudyDesign: Descriptive Study. Place and Duration of study: The study was carried out at Combined Military HospitalLahore from 18.6.07 to 18.12.2007. Patients and methods: Eighty Consecutive patients, 18 years and above of bothgenders suffering from hepatic encephalopathy were included in the study. Precipitating factors of hepaticencephalopathy were identified with the help of clinical examination and investigations. Results: Majority of patients(63.8%) had one precipitating factor; more than one factorwas found in 27.5%. Upper gastrointestinal bleed (56%) andi...
Prognostic significance of hepatic encephalopathy in patients with cirrhosis
Journal of Hepatology, 1999
There are numerous studies concerning the natural history and prognostic factors in cirrhosis, the results of which are useful in selecting liver transplant candidates. However, little attention has been paid to the prognostic significance of hepatic encephalopathy despite the high frequency of this complication. Methods: We reviewed the charts of Ill cirrhotic patients who developed a first episode of acute hepatic encephalopathy to determine their survival probability and to identify prognostic factors. Results: During follow-up (12st17 months), 82 (74%) patients died. The survival probability was 42% at 1 year of follow-up and 23% at 3 years. With univariate analyses followed by a multivariate analysis, 7 out of 30 clinical and standard laboratory variables were significantly associated with poor prognosis: male sex, increased serum bilirubin, alkaline phosphatase, potassium and blood urea nitrogen, and decreased serum
A New Look at Precipitants of Overt Hepatic Encephalopathy in Cirrhosis
Digestive diseases and sciences, 2017
Overt hepatic encephalopathy (HE) is a major cause of significant morbidity and mortality in patients with liver cirrhosis. We examined the frequency and profile of the precipitating factors resulting in hospitalizations for overt HE. We conducted both retrospective and prospective studies to identify clinical precipitants of overt HE in patients with cirrhosis. The retrospective study patients were hospitalized at a large urban safety-net hospital, and the prospective study included the patients admitted at a liver transplant center. There were a total of 149 patients with cirrhosis and overt HE (91 males, mean age 55.3 ± 8.6 years) in the retrospective group and 45 patients (27 males, mean age 58.3 ± 8.2 years) in the prospective group of the study. The average MELD score was 16 ± 6.8 in the retrospective group and 22.7 ± 7.2 in the prospective group. Dehydration (46-76%), acute kidney injury (32-76%), lactulose nonadherence (about 50%), constipation (about 40%), and infections (2...
Precipitating Factors and The Outcome of Hepatic Encephalopathy in Liver Cirrhosis
2010
To determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Study Design: Cross-sectional, analytical study. Place and Duration of Study. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p < 0.05. Results: Of the 404 patients 252 (62%) were males. Hepatitis C virus was the cause of cirrhosis in 283 (70%); Child Turcotte Pugh (CTP) class C was present in 317 (78%) patients. On presentation, 17% patients had grade 1 HE while 44%, 29% and 10% had grades 2, 3 and 4 respectively. The most common precipitant of HE was spontaneous bacterial peritonitis in 83 (20.5%), constipation in 74 (18.3%) and urinary tract infection in 62 (15.3%). One hundred and forty (35%) patients had ≥ 2 precipitating factors while no precipitant was noted in 50 (12%) patients. Mean hospital stay was 4±3 days. The lesser the number of precipitants, shorter was the length of stay (p < 0.01) and lesser was the grade of HE (p=0.025). Complete reversal of HE was noted in 366 patients (91%) while the remaining had grade 1 HE on discharge. Nine (2.2%) patients died during the hospital stay. No mortality was noted in patients without precipitants. Conclusion: Patients presenting with ≥ 2 precipitating factors and advanced grade of HE had a prolonged hospital stay. Moreover, patients without precipitants had better outcomes.
Clinical Spectrum of Precipitating Factors of Hepatic Encephalopathy in Patient of Liver Cirrhosis
Objective: To determine the precipitating factors of hepaticencephalopathy (HE) in patients with liver cirrhosis Background and Objectives: Hepatic encephalopathy is an extra hepatic complication of impairedliver 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 liver.