Hepatic Encephalopathy

Complex symptoms of disruption of the central nervous system, ie, psychoneurological disorders in people suffering from hepatic insufficiency or cirrhosis of the liver, is called hepatic encephalopathy. In the presence of this disease, metabolic reversible encephalopathy, irreversible chronic brain structure disorders and edema can occur.

The diagnosis of "hepatic encephalopathy" is put about 80% of patients with cirrhosis of a different etiology, and about 20% of patients who underwent surgical interventions to form portosystemic shunting, as well as patients suffering from hepatic insufficiency.

The main reasons for the development of hepatic insufficiency, the consequence of which is hepatic encephalopathy, are:

- diffuse lesions of the liver (liver cirrhosis, chronic and acute hepatitis);

- narrowing (obturation) of the bile ducts;

- the effect on the liver of various poisonous substances (the use of poisonous fungi, certain medicines and toxic substances);

- infectious diseases;

- extensive injuries or burns;

Acute cholangitis;

- septic, as well as purulent diseases;

- thrombosis of the portal hepatic vein.

The clinical classification distinguishes between minimal hepatic encephalopathy, episodic and persistent. In addition, there are several stages of the disease:

- zero (latent) stage - absence of clinical symptoms,

- the first stage - there are disturbances in the rhythm of sleep,

- the second stage - disorientation manifests itself in time,

- the third stage - the presence of a stop and disorientation in space,

- The fourth stage is a coma.

Hepatic encephalopathy caused by acute liver pathology, for example, acute hepatitis, and encephalopathy, caused by chronic liver disease - cirrhosis, differ in the history, laboratory tests and complete clinical examination. In acute hepatitis, hepatic encephalopathy syndrome is usually more pronounced and develops faster than with liver cirrhosis.

Hepatic encephalopathy: symptoms

- Irritability, loss of interest in relatives, childishness and other personality changes;

- sleep disorder with impaired consciousness ;

- monotony of voice, slowness of speech, etc .;

- the presence of a "liver" odor from the mouth;

- presence of "clapping" tremor;

- liquid in the abdominal cavity (ascites) ;

- jaundice and liver sprouts on the skin;

- black tarry stool and vomiting with blood.

The main instrumental methods by which hepatic encephalopathy is diagnosed are: ultrasound of the abdominal cavity organs, endoscopy of the stomach, esophagus and electroencephalography. Laboratory methods such as collection of blood tests (general, biochemical, for poison, alcohol and ammonia levels), urine and feces are also used. In addition, psychometric testing of patients with the initial stages of the disease is carried out.

Hepatic encephalopathy: treatment

Treatment of such a disease, as hepatic encephalopathy, is stepwise, in which three main directions are distinguished:

1. Detection and subsequent elimination of factors that contributed to the development of hepatic encephalopathy.
2. Carry out activities aimed at reducing the formation of various toxic products and their metabolites. As well as carrying out activities that include reducing the number of food proteins, their modification, normalization of the intestinal environment and intestinal microflora, as well as stimulation of bowel evacuation.
3. The use of drugs that modify the ratio of neurotransmitters.

In addition, patients are recommended to adhere to a special diet that excludes acute and fatty foods, as well as alcohol.