Hepatic encephalopathy

The hepatic encephalopathy is a neuropsychiatric syndrome complex characterized by modifications of the state of consciousness and Comportement, changes of Personnalité, signs neurological and changes with the electroencephalogram (EEG). It can be acute and reversible (acute hepatic Insuffisance, factors precipitants in situation of hepatic damage chronic) or chronicle and irreversible.

Pathogenesis

The main cause of hepatic encephalopathy is the association of a hépato-cellular insufficiency and shunt-Oporto-systemic caused by the Hypertension portale.

An unquestionable relation exists between hepatic encephalopathy and the increase in the serum Ammonium, which would have a direct toxic effect on the Cerveau. Other metabolites as the mercaptans would be also neurotoxic. In addition, certain neuro-transmitters degraded in the Liver, like GABA, could be in excess in the brain and take part in the deterioration of the level of vigilance. Lastly, certain arguments plead in favor of a possible role of the Manganèse; indeed, the translating scanner encephalic watch of the images of the deposits of this element in the Globus pallidus.

Clinical demonstrations

Four stages, which go from the Euphorie/depression, moderate Confusion and faded circadian cycles with the Coma:

Astérixis
Fetor hepaticus
Stages varied from the deterioration of the mental statute (lapses of memory, lethargy, changes of mood, somnolence)
cerebral Edema with intracranial Hypertension

Diagnosis

EEG plays a decisive part in the diagnosis by showing typical aspects of metabolic Encéphalopathie, in particular the triphasic waves which are easily identifiable elements of layout EEG. At each clinical stage a stage corresponds electroencephalographic, the triphasic waves defining stage III.

Factors precipitants

Déshydratation
Infection
digestive Saignement (brings dehydration and production of ammonia and other nitrogenic substances by the bacteria)
hydro-electrolytic Constipation
Déséquilibre
Médications which depresses SNC (Benzodiazépine S, Narcotique S)
Ingestion increased by proteins

Treatment

To eliminate the starting factor and to decrease serum ammonia. The Lactulose, a nonabsorbable disaccharide, is used as osmotic Laxatif and can be useful. A antibiothérapie by Ciflox is proposed in the event of digestive hemorrhage to limit the bacterial proliferation. The contribution proteinic must be restricted in order to reduce the endogenous production of ammonia.

Random links: