24Mar

Hepatic encephalopathy: stages, diagnosis and treatment

If, in ascites and liver abscess, the symptomatology is manifested only in a change in physiological functions, hepatic encephalopathy entails a change in behavior and consciousness, a decrease in intelligence. All this is accompanied by muscle pain and other disorders. If you miss the moment and do not start therapy in time, the consequences of the disease can become irreversible.

Causes, symptoms and stages of hepatic encephalopathy

Hepatic encephalopathy( PE) is a complex of mental and neuromuscular disorders( often reversible in the initial and irreversible in the terminal stage) that develop in acute and chronic liver diseases due to disruption of its most important functions.

Reasons for

The liver of hepatic encephalopathy is liver cirrhosis, acute and chronic hepatic insufficiency, alcoholic, viral and toxic hepatitis, various poisoning.

At present, the etiology of PE is not yet well understood, but many researchers believe that it is based on metabolic disorders.

Encephalopathy is the result of toxic effects on the central nervous system of metabolic products of nitrogen compounds, which the liver of a sick person can not inactivate. It is no accident that in 90% of patients with PE the level of ammonia in the blood is significantly increased.

Symptoms of hepatic encephalopathy are:

  • a change in consciousness, intelligence, behavior;
  • muscle disorders.

The main criterion for determining the stage of hepatic encephalopathy is the state of consciousness:

  • I stage. Absorption, decreased activity and ability to concentrate, slowing of mental reactions and speech, periods of stupor with fixation of sight or euphoria with insignificant psychomotor agitation, sometimes turning into aggressiveness, violation of arithmetical count, sleep disorder( sleeplessness at night and drowsiness during the day).
  • II stage. Drowsiness, apathy, inadequate behavior, untidiness, aggressiveness, violation of orientation in time, tremor, monotony of speech.
  • III stage. Stupor, pronounced disorientation in time and space, incoherent speech, delirium, aggression, liver odor from the mouth, hypo- or hyperreflexia, tremor, convulsions.
  • IV stage . Coma : loss of consciousness, disappearance of reactions to pain stimuli. There are acute and latent( latent) PE.In the absence of clinical signs, special psychometric testing often reveals neuropsychiatric disorders in patients suffering from severe liver diseases.

Diagnosis and treatment of hepatic encephalopathy

Diagnosis of hepatic encephalopathy is performed using the following methods:

  • revealing the liver disease underlying PE;
  • general and biochemical blood tests, general urine analysis;
  • examination of cerebrospinal fluid;
  • electroencephalography;
  • method of evoked potentials;
  • scan of the brain;
  • psychometric testing.

Treatment of hepatic encephalopathy includes:

  • diet( restriction of protein intake, which reduces the formation of ammonia in the large intestine);
  • drug therapy;
  • liver transplantation.