Arif, A (2020) Clinical Spectrum of Precipitating Factors of Hepatic Encephalopathy in Cirrhosis of Liver. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
Hepatic encephalopathy (HE) is a complex, potentially reversible neuropsychiatric condition that occurs as a consequence of acute or chronic liver disease. Hepatic encephalopathy may arise spontaneously but more commonly will develop as a result of some precipitating factor in the course of acute or chronic liver disease. Early identification of precipitating factors is extremely important in diagnosis and treatment of this fatal condition. The clinical course of hepatic encephalopathy can be interrupted in majority of patients by controlling these precipitating factors. Thus this study aims at studying the clinical profile and the spectrum of precipitating factors of hepatic encephalopathy in cirrhosis of liver. Hence early and accurate diagnosis and proper identification of precipitating factors will help in initiating the appropriate treatment and thereby bringing down the morbidity and mortality. AIMS AND OBJECTIVES: 1. To study the clinical profile of hepatic encephalopathy in chronic liver diseases. 2. To study the clinical spectrum of precipitating factors of hepatic encephalopathy in patients with cirrhosis of liver. MATERIALS AND METHODS: Known chronic liver disease patients, presented with signs and symptoms of hepatic encephalopathy admitted to medical wards and Medical Gasteroenterology wards in Tirunelveli Medical College Hospital during march 2018 to march 2019 were studied. A minimum of 80 cases of cirrhosis liver were studied. Past medical records, clinical signs of cirrhosis liver and an unequivocal ultrasonography report were relied for the diagnosis of cirrhosis liver. Grades of HE and Child-Pugh scores were determined. Inclusion criteria: • Patients with age more than 18 years. • Patients with clinical signs and symptoms of hepatic encephalopathy. Exclusion criteria: • Patients of age less than 18 years. • Patients who presented with acute fulminant hepatitis and non cirrhotic portal hypertension. Parameters of comparison and statistical methods: Facts and figures will be represented using appropriate charts and graphs different statistical tools will be used as required. RESULTS: The precipitating factors of HE in our studied cases were upper GI bleeding in 50 patients (62%), constipation in 36 patients (45%), infections in 14 patients (17.5%), excess protein intake in 12 patients (15%), electrolyte imbalance, hyponatremia 19 patients (23.7%) and hypokalemia 5 patients (6.2%). Male patients were predominant in this study who presented with HE. And majority of the males, the primary cause of cirrhosis of liver was found to be alcoholism. Upper GI bleeding, infections and altered bowel habits were the leading precipitating factor in causation of death with a higher prevalence in grade IV Hepatic encephalopathy. CONCLUSIONS: Our data revealed that upper GI bleeding, infections and altered bowel habits are the main precipitating factors of Hepatic encephalopathy as well as the major leading causes of death in patients with liver cirrhosis. Priority should be given to control these factors by allocation of the hospital funds, medications, and human efforts. Hence the early detection and diagnosis of these precipitating factors helps in starting treatment of this fatal condition hence reducing the mortality.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201711354 |
| Uncontrolled Keywords: | Cirrhosis, Hepatic encephalopathy, Child pugh score, Precipitating factors. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Jan 2021 18:29 |
| Last Modified: | 29 Jan 2021 05:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13318 |
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