Hepatic encephalopathy

Hepatic encephalopathy is a symptomatic complex of disorders of the central nervous system that occurs with hepatic insufficiency.

Hepatic coma is the most severe stage of hepatic encephalopathy, expressed in the loss of consciousness, the lack of response to all stimuli.

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Causes of hepatic encephalopathy

Acute diseases and liver damage:

1. Acute viral hepatitis A, B, C, D, E, G.
2. Acute viral hepatitis caused by herpes viruses, infectious mononucleosis, Coxsackie, measles, cytomegalovirus.
3. Jaundice leptospirosis (Vasiliev-Weil disease).
4. Lesion of the liver with rickettsiosis, mycoplasmal, fungal infections (in severe course with generalized lesion of all organs).
5. Septicemia with liver abscess and purulent cholangitis.

Causes of hepatic encephalopathy

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The pathogenesis of hepatic encephalopathy

The pathogenesis is not fully understood. The research shows the dysfunction of several neurotransmitter systems. With hepatic encephalopathy, a complex set of disorders is observed, none of which provides an exhaustive explanation. As a result of violations of liver clearance or peripheral metabolism in patients with cirrhosis, the level of ammonia, neurotransmitters and their precursors, which affect the brain, increases.

The pathogenesis of hepatic encephalopathy

Symptoms of hepatic encephalopathy

When hepatic encephalopathy affects all parts of the brain, so the clinical picture is a complex of different syndromes. It includes neurological and mental disorders. A characteristic feature of hepatic encephalopathy is the variability of the clinical picture in various patients. It is easy to diagnose encephalopathy, for example, when entering a hospital with gastrointestinal bleeding or sepsis, a patient with cirrhosis of the liver, when examined, reveals confusion and a "clapping" tremor.

Symptoms of hepatic encephalopathy

Stages of hepatic encephalopathy

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

• Consciousness is preserved, patients complain of pronounced general weakness, lack of appetite, nausea, bitterness in the mouth, hiccups, pain in the right hypochondrium, dizziness, "flashing of flies" before the eyes, headache, tinnitus;
• patients adequately answer questions, recognize others, but periodically cease to navigate in time, in space (they may not understand where they are, do not call the day of the week, etc.);
• often there is excitement, fussiness, emotional lability, euphoria (they say they feel fine);

Stages of hepatic encephalopathy

Diagnosis of hepatic enephalopathy

In clinical practice, it is important to distinguish between hepatic encephalopathy, which develops in acute and chronic liver diseases. In general, the symptomatology is similar, but with acute liver damage 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. Establishment 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 that form in the large intestine. These include reducing the amount and modification of food proteins, altering the intestinal microflora and intestinal

Treatment of hepatic encephalopathy

Prognosis of hepatic encephalopathy

The prognosis of hepatic encephalopathy depends on the severity of the liver-cell insufficiency. In patients with relatively safe liver function, but with intensive collateral circulation in combination with an increased content of nitrogenous compounds in the intestine, a better prognosis, and worse in patients with acute hepatitis.

Prognosis of hepatic encephalopathy

Background

The influence of the liver on mental activity has been known since ancient times. Around 2000 BC. The Babylonians considered the liver a source of abilities for prediction and clairvoyance and used the name of this organ as the word for "soul" or "mood." In ancient Chinese medicine (Neiching, 1000 BC), the liver was regarded as a storehouse of blood and a receptacle for the soul. In 460-370 years. BC. Hippocrates described the patient as a hepatitis, who "barked like a dog, could not stop and said things that could not be understood."

[13], [14]