11.03.2017 Views

DR Medhat MRCP

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Hepatic Encephalopathy:<br />

• Def: A spectrum of neuropsychiatric abnormalities in patients with liver failure, after<br />

of other known brain disease.<br />

• Pathogenesis :<br />

- Inhibition of the brain function by noxious agents reaching the brain from GIT after :<br />

Failure of the liver to detoxify them.<br />

Bypassing the liver unchanged through porto-systemic shunting.<br />

- These noxious agets are amonia, aromatic chain aa ,GABA (inhibitory transmitter).<br />

Clinical features (stages):<br />

Grade<br />

0<br />

Minimal HE<br />

1<br />

Early HE<br />

2<br />

Pre-coma<br />

3<br />

Light coma<br />

(stuper)<br />

4<br />

Deep coma<br />

Features<br />

Subclinical<br />

Normal mental status.<br />

Minimal change in memory , concentration & intellectual functions.<br />

Mild confusion.<br />

Euphoria or depression<br />

Inverted sleep rhythm.<br />

Drowsiness.<br />

Confusion .<br />

Lethargy.<br />

Personality changes.<br />

Flapping tremors<br />

Marked confusion but respond to painful ++.<br />

Disoriented with time,persons & places.<br />

Flapping tremors<br />

Not responding.<br />

No flapping tremors<br />

No muscle tone<br />

Foetor hepaticus.<br />

83

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