Minimal hepatic encephalopathy in children with extra hepatic portal vein obstruction.

Raja Yogesh, K (2014) Minimal hepatic encephalopathy in children with extra hepatic portal vein obstruction. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Extra-Hepatic Portal Vein Obstruction is one of the vascular disorders of the liver. It is said to occur when there is obstruction to the extra hepatic part of the portal vein with or without the involvement of the intrahepatic part, splenic vein or the superior mesenteric vein. In children, it accounts for nearly 70% of the cases of portal hypertension and is the commonest cause of upper GI bleed in them. In Adults, EHPVO is responsible for nearly one-third of cases of portal hypertension. Etiologically, EHPVO is a heterogeneous disease and the cause varies with respect to age and geographic location. Umbilical sepsis, umbilical vein catheterisation, intra-abdominal sepsis, congenital malformations of the portal vein, hypercoagulable states, trauma have all been documented as possible etiological factors. However, despite the best of efforts, a clear aetiology remains elusive in a vast majority of cases. Patients with EHPVO can present in two clinical forms: 1) Acute form and 2) Chronic form, with the latter being distinctly more common than the former. In its acute form, patients may present with acute abdominal pain sometimes associated with low grade fever and rarely as transient ascites. In its more common Chronic form, patients present with variceal bleeding, moderate to massive splenomegaly and features suggestive of hypersplenism. Rarely patients may present with jaundice secondary to portal biliopathy. This study aims to evaluate children with EHPVO for the existence of MHE by using Psychometric tests and Critical flicker Frequency. I believe that establishing the presence of MHE in children with EHPVO would lay the foundation for treatment modalities, with the potential to improve scholastic performance and overall intellectual and psychological development of these children. AIMS OF THE STUDY : To study the clinical profile of children with Extra-Hepatic Portal Vein Obstruction, To study the prevalence of minimal hepatic encephalopathy in these children, using 1. Psychometric Tests, 2. Critical Flicker Frequency. CONCLUSIONS : 1. Minimal Hepatic Encephalopathy does exist in children with Extra Hepatic Portal Vein Obstruction. 2. Prevalence is as high as 50% when psychometric tests are used and 46% when Critical Flicker Fusion is used. 3. Digit Symbol Test, Number Connection Test - B are highly sensitive among psychometric tests in detecting Minimal Hepatic Encephalopathy and can be used as initial screening tests. 4. Critical Flicker Fusion has a good sensitivity and specificity in detecting Minimal Hepatic Encephalopathy and correlated well with psychometric tests.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Minimal hepatic encephalopathy ; children ; hepatic portal vein obstruction.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:12
Last Modified: 13 Jul 2017 04:12
URI: http://repository-tnmgrmu.ac.in/id/eprint/1569

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