A Study on Minimal Hepatic Encephalopathy.

Antony Joe, J (2009) A Study on Minimal Hepatic Encephalopathy. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Minimal Hepatic Encephalopathy (MHE) is the earliest stage of hepatic encephalopathy and is associated with changes in cognitive functions, in electrophysiological parameters and in cerebral neurochemical/ neurotransmitter homeostasis. MHE can be observed in patients with cirrhosis who have no clinical evidence of hepatic encephalopathy. Prevalence is estimated to be about 30% - 60% in cirrhotics without overt clinical signs of hepatic encephalopathy 1-7 . Probability of clinical hepatic encephalopathy after follow up of 3years was estimated to be 50% in patients with MHE compared to 8% in cirrhotics without MHE, whether this course of events is affected by early treatment needs to be studied. MHE often manifested with sleep disturbances or subtle behavioral changes that are more apparent to the patient’s family than to the clinician. The behavioral changes are due predominantly to subtle impairment of cognitive function resulting from bilateral dysfunction of forebrain and parieto-occipital regions, because verbal abilities are usually preserved in this stage of hepatic encephalopathy. Cerebral dysfunction is not detectable by the routine clinical examination but only by neuropsychological or neurophysiological measures. Patients with MHE perform worse than healthy controls especially in tests of psychomotor speed, visual perception and attention. Some of these patients also show a pathologic slowing of the electroencephalogram (EEG) and Prolonged Latencies of Exogenous (Visual Evoked Potentials (VEP), Somatosensory Evoked Potentials (SSEP) and Brainstem Auditory Evoked Potentials (BAEP) and endogenous evoked potentials (P300). A consensus has emerged that patients with MHE should be treated. Only limited numbers of studies are available to analyze the importance of encephalopathy. Hence psychometric and neurophysiological tests to diagnose minimal hepatic encephalopathy. AIM OF THE STUDY : To find out the prevalence of Minimal Hepatic Encephalopathy in cirrhotic patients with the help of Number connection test (NCT), Electroencephalogram (EEG) and Brainstem auditory evoked potential (BAEP). CONCLUSION : Minimal Hepatic Encephalopathy is proved undoubtedly impairs quality of life observed in patients with cirrhosis who have no overt encephalopathy, medical intervention can improve both cognitive function and health related quality of life. Hence screening for Minimal Hepatic Encephalopathy is important in cirrhotics to provide them a good quality of life, driving skills which is impaired in Minimal Hepatic Encephalopathy by interfering at the early stage of the disease to prevent progression to overt encephalopathy which has got a high mortality. Diagnosis of MHE requires high index of suspicion, useful three diagnostic tools are NCT, EEG and BAEP. This study showed 48% had abnormal NCT, 30% had abnormal EEG, 24% had abnormal BAEP with combined prevalence of MHE 64%. This study suggested that Number connection test (NCT), Electroencephalogram (EEG) and Brainstem auditory evoked potentials (BAEP) are valid tools for the screening of minimal hepatic encephalopathy in cirrhotic patients of various etiology as there is a greater likelihood of overt encephalopathy development in the immediate follow up period in patients with an abnormality detected by these tests than in patients with no such abnormality. Seven patients developed overt encephalopathy within a period of 2months in the one year follow up period. Large scale study may be needed to enlighten these aspects. These tools can be used for screening for MHE in patients with cirrhosis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Minimal Hepatic Encephalopathy.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:06
Last Modified: 13 Jul 2017 04:06
URI: http://repository-tnmgrmu.ac.in/id/eprint/1556

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