Hepatic encephalopathy- A brain disease linked to the liver (1)

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Hepatic Encephalopathy
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Hepatic Encephalopathy

• Hepatic encephalopathy is a brain disorder
  caused due to a complication in the liver. The
  term hepatic stands for "of the liver" and
  encephalopathy stands for "brain
  disorder."Hepatic encephalopathy is most
  commonly observed in patients of cirrhosis. It
  occurs when the toxic substances, which are
  normally removed by the liver, accumulate in the
  blood and reach the brain. This is caused due to
  liver impairment and is marked by a disturbance
  in mental functioning. A person affected by this
  condition is at a high risk of developing
  cerebral edema and multi-organ failure.

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Causes and risk factors of hepatic encephalopathy

• The exact cause this condition is not known, but
  it is considered to be caused by the disorders
  affecting the liver. It can also be caused due to
  an increased amount of ammonia and other harmful
  substances in the blood. People with liver
  disorders like cirrhosis or hepatitis are most
  likely to develop this disorder. In such people,
  it might be triggered by the conditions like
  diarrhoea, constipation, gastrointestinal
  bleeding, vomiting, bacterial or viral
  infection and high protein intake.It may also
  be triggered due to excessive alcohol
  consumption. Other conditions that may cause this
  condition include alkalosis, low oxygen
  levels, potassiumdeficiency caused due to
  medicines like diuretics, sedatives and narcotics.

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Symptoms

• Mild symptoms might be observed in the early
  stages of Hepatic encephalopathy. These include 
• Mood changes
• Behavioural changes
• Personality changes
• Drowsiness
• Decreased attention
• Difficulty in speaking
• Deterioration of handwriting
• Changes in sleeping habits

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Symptoms
Continue

• With the progression of disease, some other
  symptoms might be observed. These include 
• Sleepiness
• Forgetfulness
• Confusion
• Decreased awareness
• Decreased responsiveness
• Disorientation
• Flapping tremors
• Muscle stiffness
• Seizures
• Fetor hepaticus (a musty sweet odour)
• Coma

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Diagnosis and treatment of hepatic encephalopathy

• The diagnosis of hepatic encephalopathy is done
  on the basis of physical examination, mental
  status examination, electroencephalography,
  medical history and blood tests.

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Treatments

• The treatment depends upon the severity of the
  disease. The main goal of the treatment is to
  address the underlying cause, and eliminate the
  toxic substances from the intestine. Toxic
  substances are removed from the intestine by
  restricting a person's diet. The affected person
  might be asked to reduce protein intake in order
  to lower ammonia production. Instead, he may be
  asked to increase the amount of vegetable protein
  so that he gets adequate protein, but without
  worsening the condition. Carbohydrates that are
  given either orally or intravenously serve as the
  main source of calories. A person may also be
  asked to eat the vegetables high in fibre
  content.

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Treatments
Continue

• This helps in speeding up the passage of food
  through intestine, altering the intestinal
  acidity and thereby reducing the absorption
  of ammonia. 
• Lactulose may be given orally to acidify the
  ammonia in the colon and form the ammonium that
  can be easily excreted. It is used as a laxative
  for evacuating blood from intestines and for
  reducing ammonia production by intestinal
  bacteria. Gastrointestinal bleeding should also
  be controlled. Medications may also be provided
  to increase bowel movements to reduce the
  absorption of toxins and ammonia from the blood.

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Treatments
Continue

• Severe cases of hepatic encephalopathy usually
  require hospitalisation. For proper and better
  intake of oxygen, ventilator may be used.
  Artificial liver support may also be used to
  clean the blood. Your blood is passed through a
  special filter and this filtered blood is
  returned to you. Sometimes, a surgery or liver
  transplantation may also be required.

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