Study to assess the changing pattern of clinical profile and determine the prognosis in hepatic encephalopathy (original) (raw)
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Journal of the Pakistan Medical Association
To determine the precipitating factors of hepatic encephalopathy (HE) in patients with liver cirrhosis at Liaquat University Hospital Hyderabad/Jamshoro. This hospital based descriptive study was conducted from April 2007 to September 2007. All the patients who were more than 12 years of age and were diagnosed as hepatic encephalopathy were studied. During this period, 87 patients of hepatic encephalopathy were admitted. All patients were carefully examined, relevant investigations were performed and data was collected through pre-designed proforma. Male patients were 65 (75%), above 40 years of age 58 (67%), belonging to interior/periphery of Sindh 54 (62%), in grade IV of hepatic encephalopathy 70 (80%) and Anti-HCV positive were 52 (60%). The most common precipitating factors detected were infection 58 (67%), constipation 43 (49%) and gastrointestinal bleeding 39 (45%). Out of 87 patients, 68 had increased total leucocytes count, 09 patients had hypokalaemia, 24 patients, hyponat...
Precipitating factors of hepatic encephalopathy at a tertiary care hospital Jamshoro, Hyderabad
JPMA. The journal of the …, 2009
According to auspices of the World Congress of Gastroenterology, there are four types of hepatic encephalopathy (a) Acute, (b) Recurrent (c) Persistent (d) Minimal or sub-clinical. The hepatic encephalopathy is a diagnosis of exclusion 6 and has four grades. There are several precipitating factors for HE such as infection, gastrointestinal 683 J Pak Med Assoc Original Article Precipitating factors of hepatic encephalopathy at a tertiary care hospital Jamshoro, Hyderabad Abstract Objective: To determine the precipitating factors of hepatic encephalopathy (HE) in patients with liver cirrhosis at Liaquat University Hospital Hyderabad/Jamshoro. Methods: This hospital based descriptive study was conducted from April 2007 to September 2007. All the patients who were more than 12 years of age and were diagnosed as hepatic encephalopathy were studied. During this period, 87 patients of hepatic encephalopathy were admitted. All patients were carefully examined, relevant investigations were performed and data was collected through pre-designed proforma. Results: Male patients were 65 (75%), above 40 years of age 58 (67%), belonging to interior/periphery of Sindh 54 (62%), in grade IV of hepatic encephalopathy 70 (80%) and Anti-HCV positive were 52 (60%). The most common precipitating factors detected were infection 58 (67%), constipation 43 (49%) and gastrointestinal bleeding 39 (45%). Out of 87 patients, 68 had increased total leucocytes count, 09 patients had hypokalaemia, 24 patients, hyponatraemia, 64 hypoalbuminaemia and 54 patients had a disturbed coagulation profile. Fifty nine patients recovered and were discharged while 20 patients expired. Majority of expired patients had Child-Pugh score 10-15 and were in grade IV of hepatic encephalopathy. Conclusion: The study concluded that there were different factors which play a key role in hepatic encephalopathy. In these factors, infection was the most common (JPMA 59:683; 2009).
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...
2006
Background: 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. There are numerous factors of hepatic encephalopathy. The main objective of this study was to analyse the precipitating factors of hepatic encephalopathy in cases seen in Pakistan Institute of Medical Sciences Islamabad.
Introduction: Doctors in hospital practice often face chronic liver disease (CLD). Hepatic encephalopathy is a serious complication of chronic liver disease, most commonly in people with advanced cirrhosis. In patients with stable cirrhosis, hepatic encephalopathy is often followed by easily identifiable triggering events. The aim of the study is to understand the triggering factors and their frequency in CLD patients with hepatic encephalopathy in order to prevent mortality and morbidity. Methods: This descriptive observational study was conducted to identify triggers and their frequency among 50 cases of diagnosed chronic liver disease with hepatic encephalopathy at the Medicine department of Jalalabad Ragib-Rabeya Medical College & Hospital, Bangladesh for one-year duration from March 2019 to March 2020. Results: Among 50 patients, 36 patients (72%) were men, 14 (28%) women. The study found that the incidence of age 14 (28%) was 41 to 50 years, and 08 (16%) 51 to 60 years, 12 (24%)> 60 years. Of the 50 patients, the etiology of cirrhosis was hepatitis B virus in 28 (56%), hepatitis C virus in 4 (8%), both hepatitis B and C in 02 (4%). Among 50 patients 13 (26 %)) were grade 3 and 11 (22%) in grade 2 hepatic encephalopathy. According to Child-Pugh with a score of 16 (32%) in class C and 09 (18%) in class B. The most common triggers were gastrointestinal bleeding (28%), infection (26%), mixed (16%) and unknown (20%). In this study, the mortality rate was 32% of the majority of patients in Child-Pugh Class C. Conclusions: The most common triggers of hepatic encephalopathy in this study were the upper G.I. bleeding, infection, mixed factor and electrolyte imbalance. To prevent hepatic encephalopathy, caution should be exercised in administering diuretics to patients with chronic liver disease. Maintaining early and effective infection control measures and better hygiene conditions in government hospitals are imperative.
Impact of the underlying cause and co-morbid conditions on the outcome of hepatic encephalopathy
International Journal of Research in Medical Sciences, 2016
Background: Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of acute and chronic liver diseases. This study aimed at identifying liver diseases and co-morbidity conditions associated with hepatic encephalopathy (HE) and their impact on patient`s mortality (the outcome). Methods: A hospital-based, prospective study enrolled 76 patients admitted with HE conducted at Ibn Sina specialized gastroenterology hospital, Sudan, from January 2010 to May 2011. Personal data, clinical presentation, underlying liver disease, precipitants, co-morbid conditions and the outcome of HE were obtained from the inpatients' hospital records. Results: A total of 76 patients were included, 62 males (81.5%) and 14 females (18.5%) aged between 13 and 84 years old. Hepatitis B virus (HBV) was the most common cause of the liver disease (36.8%), followed by HCV (11.8%). Clinically, 53 patients (69%) had impaired level of consciousness. Infection was the most common risk factor for HE (54%) followed by electrolyte disturbance (42%). Overall mortality within one to three weeks following the admission was (50%). The higher percentage of mortality was seen inpatients with late stage autoimmune hepatitis, followed by HCC and in co-morbid conditions like renal impairment (58.8%). Conclusion: HE is associated with a high mortality despite proper management in specialized hospitals. The mortality tends to increase in the presence of comorbid condition.
Chronic liver disease and hepatic encephalopathy: Clinical profile and outcomes
Nigerian Journal of Clinical Practice, 2011
Background: Hepatic encephalopathy (HE) is an important neuropsychiatry complication of liver disease causing significant morbidity and mortality worldwide. Efforts at improving the outcome have resulted in development of new strategies in the management given the background of new insights in the pathogenesis of this disease entity. Understanding the disease profile including precipitants as well as prognostic factors will contribute in this regard as new strategies are yet to be widely applied. The aim of this report is to document the profile of patients with HE, the precipitants, prognostic factors as well as the scope of the burden associated with it. Materials and Methods: In this prospective study, all patients managed for HE from January to December 2008 were recruited. A questionnaire was used to extract their basic demographics, clinical features noting any possible precipitants, complications, management protocol as well as outcome. Results: A total of 21 subjects (11 females and 10 males) within the age range of 16-83 years were seen during the period under review. (mean age 57.9 ± 13). There was no significant difference in the mean ages of males and females. Two patients had acute encephalopathy, while others had acute-on chronic encephalopathy. The risk factors for liver disease included significant alcohol ingestion, hepatitis B virus infection, and previous jaundice, while other complications of liver disease noted were deepening jaundice, ascites, bleeding tendencies, and renal failure. The identified precipitants for HE were sepsis 6 (29%), electrolyte inbalance 3 (14%), gastrointestinal bleed 5 (24%), drugs (5%), and possible malignant transformation 6 (29%). Focus of sepsis was bacterial peritonitis in two cases. Majority of our patients (61%) came during advanced stage of liver disease (Child-Pugh class C). Length of hospital stay ranged from 1 to 7 weeks and a mortality of 48% was observed. Predictors of mortality were a history of significant alcohol ingestion, previous blood transfusion, Hepatitis B and C infections, and severe liver dysfunction on presentation (Child-Pugh class C). Conclusions: HE is associated with a high mortality rate and this scenario is associated with a history of previous blood transfusion, Hepatitis B and C infections, and severe liver dysfunction on presentation. Measures to reduce the burden of viral Hepatitis B and C, safe blood transfusion, and responsible use of alcohol should be promoted. Screening of those at risk of encephalopathy (liver disease patients) with a psychometric test of good predictability should be part of their routine evaluation in daily practice so as to detect cases of latent encephalopathy. Intensive care facilities and necessary personnel should be provided.
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 ...
EVALUATION OF SUB-CLINICAL HEPATIC ENCEPHALOPATHY BY PSYCHOMETRIC TESTS
Objective: To evaluate the sub-clinical hepatic encephalopathy by psychometric tests. Patients and Methods: The cross sectional study of six months was conducted at the tertiary care hospital Hyderabad. The inclusion criteria were the patients of ≥12 years of age, either gender, diagnosed to have cirrhosis of liver by history, clinical examination, laboratory findings, ultrasonography and liver biopsy and spare from the medications the impaired the cognitive function. A detailed clinical history, physical examination including neuropsychological tests [NCT and DST] and the baselines and specific relevant investigations were advised and the data was collected on predesigned proforma. The frequency and percentages was calculated while the numerical statistics were used to compute mean ±SD. Results: Thirty patients with histologically proven cirrhosis were recruited and studied for subclinical hepatic encephalopathy during six months study period. The mean age ± SD for whole population was 43.98 ± 7.83 years with male gender predominance (66.6%) while the mean ± SD for DST and NCT was 241.82±5.83 and 152.98±7.75. The common etiologies identified were Hepatitis B (40%), hepatitis C (33.3%) and hepatitis B and C (16.6%) while DST and NCT were shown to be abnormal in 17 (56.6%) and 18 (60%) individuals with chronic liver disease respectively. Conclusion: The sub clinical hepatic encephalopathy on the basis of NCT and DST could better predict a subsequent episode of overt hepatic encephalopathy in chronic liver disease.