Hepatic Encephalopathy
Sedatives can tip a cirrhotic patient into hepatic encephalopathy.
HEPATIC ENCEPHALOPATHY
- Metabolic disorder of CNS + neuromuscular system - Associated with severe hepatocellular dysfunction + portosystemic shunting - Pathogenesis : ammonia → neuronal dysfunction + generalized brain edema ⭐ - Asterixis = flapping tremor = hallma
Read this in Liver Histology & Physiology
HEPATIC ENCEPHALOPATHY
- Metabolic disorder of CNS + neuromuscular system - Associated with severe hepatocellular dysfunction + portosystemic shunting - Pathogenesis : ammonia → neuronal dysfunction + generalized brain edema ⭐ - Asterixis = flapping tremor = hallma
Read this in Liver Histology & Physiology
Hepatic Encephalopathy
- Elevated ammonia + proinflammatory cytokines
- Alzheimer type II cells — astrocytes with enlarged nuclei, minimal cytoplasm; in cerebral cortex, basal ganglia, subcortical gray matter
Read this in Pathology of Demyelinating Diseases: MS, NMO, ADEM, CPM
What our notes say
- Sedatives can tip a cirrhotic patient into hepatic encephalopathy. (Internal Medicine CAT 1 (MBChB 4), 2022: liver, pancreas and bone marrow, 30 MCQ)
- Ascites and abdominal swelling, haematemesis and melaena (varices), splenomegaly, caput medusae, hepatic encephalopathy (confusion, flapping tremor), jaundice, pedal oedema and fatigue, with spider naevi, palmar erythema and wasting in chronic liver disease. (Junior Clerkship in Internal Medicine (MBIM4100) main exam, Paper One: 31 Januar)
- Probable diagnoses: metabolic (hypoglycaemia, hyponatraemia, uraemia, hepatic encephalopathy, hypercalcaemia), infection (meningitis, sepsis, cerebral malaria, urinary infection), drugs and alcohol, stroke or head injury, and thyroid disease. (Internal Medicine (MBIM 4100) special/supplementary exam, Paper Two: 14 August 2)
- Hepatic encephalopathy sets in with severe liver dysfunction and with classical symptoms of asterixis (Paediatrics end of second semester exam (MBPE 4300): 4 October 2022, cardiology,)
- Missing hepatic encephalopathy: blood in the gut can trigger it, so treat with lactulose. (Upper gastrointestinal bleeding)
- Complications: portal hypertension, ascites, oesophageal varices, hepatic encephalopathy, hepatocellular carcinoma (Pathology Practical Revision Guide)