hepatic encephalopathy

Hepatic encephalopathy is a symptom complex of disorders of the central nervous system that occurs with liver failure.

Hepatic coma is the most severe stage of hepatic encephalopathy, characterized by loss of consciousness and lack of response to all stimuli.

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Causes of hepatic encephalopathy

Acute liver diseases and lesions:

1. Acute viral hepatitis A, B, C, D, E, G.
2. Acute viral hepatitis caused by herpes viruses, infectious mononucleosis, Coxsackie, measles, cytomegalovirus.
3. Icteric leptospirosis (Vasiliev-Weil disease).
4. Liver damage due to rickettsiosis, mycoplasma, fungal infections (in severe cases with generalized damage to all organs).
5. Septicemia with liver abscesses and purulent cholangitis.

Causes of hepatic encephalopathy

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Pathogenesis of hepatic encephalopathy

The pathogenesis is not fully understood. Studies have shown dysfunction of several neurotransmitter systems. In hepatic encephalopathy, a complex set of disorders is observed, none of which provides a comprehensive explanation. As a result of impaired liver clearance or peripheral metabolism, patients with liver cirrhosis have elevated levels of ammonia, neurotransmitters and their precursors, which affect the brain.

Pathogenesis of hepatic encephalopathy

Symptoms of liver encephalopathy

In hepatic encephalopathy, all parts of the brain are affected, so the clinical picture is a complex of various syndromes. It includes neurological and mental disorders. A characteristic feature of hepatic encephalopathy is the variability of the clinical picture in different patients. Encephalopathy is easy to diagnose, for example, in a patient with liver cirrhosis admitted to hospital with gastrointestinal bleeding or sepsis, whose examination reveals confusion and a "flapping" tremor.

Symptoms of liver encephalopathy

Stages of hepatic encephalopathy

Stage I (precursors of coma, precoma I) is characterized by the following symptoms:

• consciousness is preserved, patients complain of severe general weakness, loss of appetite, nausea, bitterness in the mouth, hiccups, pain in the right hypochondrium, dizziness, “flickering spots” before the eyes, headache, tinnitus;
• patients adequately answer questions, recognize others, but periodically lose their bearings in time and space (they may not understand where they are, not be able to name the day of the week, etc.);
• excitement, fussiness, emotional lability, euphoria are often observed (they claim that they feel great);

Stages of hepatic encephalopathy

Diagnosis of hepatic encephalopathy

In clinical practice, it is important to distinguish between hepatic encephalopathy developing in acute and chronic liver diseases. In general, the symptoms are similar, but in acute liver lesions, all manifestations of hepatic encephalopathy progress much faster than in chronic ones.

Diagnosis of hepatic encephalopathy

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Treatment of hepatic encephalopathy

Treatment of hepatic encephalopathy can be divided into three main points:

1. Identification and elimination of factors contributing to the development of hepatic encephalopathy.
2. Measures aimed at reducing the formation and absorption of ammonia and other toxins formed in the colon. These include reducing the amount and modification of dietary proteins, changing the intestinal microflora and the intestinal environment.

Treatment of hepatic encephalopathy

Prognosis of hepatic encephalopathy

The prognosis of hepatic encephalopathy depends on the severity of hepatocellular insufficiency. In patients with relatively intact liver function, but with intensive collateral circulation in combination with an increased content of nitrogen compounds in the intestine, the prognosis is better, and in patients with acute hepatitis, it is worse.

Prognosis of hepatic encephalopathy

History of the issue

The influence of the liver on mental activity has been known since ancient times. Around 2000 BC, the Babylonians considered the liver to be the source of divination and clairvoyance, and used the name of this organ as a word meaning "soul" or "mood." In ancient Chinese medicine (Neiching, 1000 BC), the liver was considered a blood reservoir and a seat of the soul. In 460-370 BC, Hippocrates described a patient with hepatitis who "barked like a dog, could not stop, and said things that were impossible to understand."

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