Spectrum of Precipitating Factors of Hepatic Encephalopathy in Cirrhosis of Liver

Siva, P K (2009) Spectrum of Precipitating Factors of Hepatic Encephalopathy in Cirrhosis of Liver. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION Liver diseases affect millions of people worldwide each day. However, in the developing countries where cost of health care has always been an issue, long lasting diseases such as liver cirrhosis and its complications are a major health problem and pose a big challenge to the health economy. Because of poverty, poor hygienic conditions, inadequate education and lack of counseling, the number of cirrhotic patients is increasing and most of them are admitted to medical wards with different complications. The syndrome of hepatic encephalopathy(HE) describes all neuropsychiatric symptoms occurring in patients with acute or chronic liver diseases (CLD) in the absence of other neurological disorders. About 30% of patients with cirrhosis die in hepatic coma. Appearance of HE in any patient is indicative of poor prognosis. HE can occur either due to acute liver failure or due to one or more precipitating factors in a cirrhotic patient, or it could happen as a result of prolonged portal systemic shunting resulting in a chronic portal systemic encephalopathy. Survival of patients having chronic portal systemic encephalopathy is better than those who develop HE acutely (100% vs. 70%). However prognosis in the later group can be improved if the precipitating factors are recognized early and managed accordingly. Common precipitating factors include gastrointestinal bleeding, infection, azotemia, constipation, electrolyte imbalance and high protein diet. Usage of drugs such as sedatives, tranquilizers, analgesics and diuretics, fulminant hepatic injury, large volume paracentesis have all been considered to precipitate encephalopathy in an otherwise stable cirrhotic patient. Exact pathogenic mechanism involved is unknown till date, however the basic processes are failure of hepatic clearance of gut derived substances such as ammonia, free fatty acids, mercaptans etc., either through hepatocellular failure or shunting, and altered amino acid metabolism, both of which result in changes in cerebral transmission causing depressed cerebral function. This study was aimed at ascertaining the common precipitating factors and their frequency in patients presenting with HE. Other objectives were to analyse the commonly associated biochemical laboratory findings in such patients, to stratify these patients according to Child’s classification of CLD, the outcome, and the etiological factors involved. AIM OF THE STUDY: This study was carried out with the main objective of ascertaining the most common precipitating factor and their frequency in a group of patients presenting with hepatic encephalopathy in diagnosed cases of cirrhosis of liver of any etiology. MATERIALS AND METHODS: Study Design: Prospective, descriptive study. Place & Duration: Department of Medicine and Gastroenterology, Government Stanley Hospital Chennai. Study Period: Study was done over a period of one year from june 2007 to June 2008. PATIENT & PROCEDURE: Inclusion Criteria: 1. Patients with cirrhosis of liver, belonging to either sex. 2. age above 12 years. 3. hepatic encephalopathy including minimal hepatic encephalopathy. Exclusion Criteria: 1. Patients with psychiatric disorders or on treatment for psychiatric Disorders. 2. Those with altered sensorium due to metabolic disease or head injury. 3. Acute alcoholic intoxication and alcoholic withdrawal states. OBSERVATION & DATA ANALYSIS: A total of 50 admitted patients, including 48(96%), male and 02 (4%) females, presenting or complicating into hepatic encephalopathy were studied. Majority i.e. 43 (86%) patients were older than 40 years including 41 (82%) males and 02 (04%) females in this group. Seven (14%) patients were between 20 and 40 years old, all of them were males. Most common presenting clinical features in the patients were ascites. Other common presentation CONCLUSION: 1. In this study 96% of patient were males and 4% of patient were females. 2. 86% of the patients were more than 40 years of age. 3. Most common etiological factor for cirrhosis of liver was alcohol intake. (76%) 4. Most common clinical presentations were ascites (92%) and Anaemia (88%). 5. Most common precipitating factor was GI bleed (60%). 6. Other important precipitating factor hyponatremia (32%), Infection (20%), hypovolemia(20%), hypokalemia (20%), constipation (16%). 7. Less common precipitating factors were dirrhoea (8%), diuretics (8%), acidosis (8%), sedatives (4%), hypoglycemia (4%). 8. 36% patients had one precipitating factors for hepatic encephalography. 9. 30% patients had two precipitating factors for hepatic encephalography. 10. 18% patients had more than two precipitating factors for hepatic encephalography. 11. 4% of patient no precipitating factors was found for hepatic encephalopathy. 12. Azotemia was also a important precipitating factor seen in 28% of patient. 13. 64% of patient were classified in class C of child-pugh classification. 14. 36% of patients were in grade 2 and 32% of patient were in grade 3 of hepatic encephalopathy grading.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Spectrum ; Precipitating Factors ; Hepatic Encephalopathy ; Cirrhosis of Liver.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 17:00
Last Modified: 24 Mar 2018 09:28
URI: http://repository-tnmgrmu.ac.in/id/eprint/6515

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