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    Hepatic Encephalopathy

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    ChenyuZhu
    This document discusses hepatic encephalopathy, which is a neurological complication of liver disease and portal hypertension. It presents the epidemiology, pathogenesis, precipitating factors, stages of disease, physical exam findings, relevant labs and imaging. It then discusses therapeutic goals of reducing nitrogen load and managing precipitating factors. Treatment includes lactulose, antibiotics, and avoiding precipitants like diuretics. The document concludes with a case presentation of a patient presenting with hepatic encephalopathy after being discharged for CHF exacerbation.

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    Hepatic Encephalopathy

    Uploaded by

    ChenyuZhu
    367 views16 pages
    This document discusses hepatic encephalopathy, which is a neurological complication of liver disease and portal hypertension. It presents the epidemiology, pathogenesis, precipitating factors, stages of disease, physical exam findings, relevant labs and imaging. It then discusses therapeutic goals of reducing nitrogen load and managing precipitating factors. Treatment includes lactulose, antibiotics, and avoiding precipitants like diuretics. The document concludes with a case presentation of a patient presenting with hepatic encephalopathy after being discharged for CHF exacerbation.

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    This document discusses hepatic encephalopathy, which is a neurological complication of liver disease and portal hypertension. It presents the epidemiology, pathogenesis, precipitating factors, stages of disease, physical exam findings, relevant labs and imaging. It then discusses therapeutic goals of reducing nitrogen load and managing precipitating factors. Treatment includes lactulose, antibiotics, and avoiding precipitants like diuretics. The document concludes with a case presentation of a patient presenting with hepatic encephalopathy after being discharged for CHF exacerbation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    367 views16 pages

    Hepatic Encephalopathy

    Uploaded by

    ChenyuZhu
    This document discusses hepatic encephalopathy, which is a neurological complication of liver disease and portal hypertension. It presents the epidemiology, pathogenesis, precipitating factors, stages of disease, physical exam findings, relevant labs and imaging. It then discusses therapeutic goals of reducing nitrogen load and managing precipitating factors. Treatment includes lactulose, antibiotics, and avoiding precipitants like diuretics. The document concludes with a case presentation of a patient presenting with hepatic encephalopathy after being discharged for CHF exacerbation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    Hepatic

    Encephalopathy
    Chenyu Zhu M.D.
    Emory University
    Department of Medicine
    Division of Digestive Diseases
    Key Points:
    Epidemiology:
    Pathogenesis:
    Precipitating Factors:
    Stages:
    Abdominal swelling.
    Nausea ,vomiting.
    Dark urine.
    Sleep disturbances.
    Caput Medusa.
    Fetor hepaticus
    Jaundice, itching
    Hepatomegaly, splenomegaly.
    Flapping tremors.
    Gynecomastia.
    Melena , fatigue.

    Physical Exam:
    Labs:
    Radiology:
    Head MRI:
    PVWM, thalami, and corticospinal tract abnormalities on
    FLAIR and DWI

    Ab CT/MRI
    Signs of portal hypertension and liver pathologies

    Ab Ultrasound
    Can be useful in emergent cases, but low
    sensitivity/specificity
    Therapeutic Goals
    Lactulose, 20 60 mL TID
    Inhibits intestinal bacterial, decreasing nitrogen load
    Neomycin 1g/6hrs
    Metronidazole 400 mg/6hrs

    Contraindications:
    Excess diuretics
    Sedatives and Hypnotics
    Hepatotoxic drugs

    Prescriptions
    Therapeutic parameters
    Bloodwork
    Serum ammonia
    Chem 14; sp Na, K, Albumin, AST, ALT, Cr, BUN

    Clinical Parameters
    Improving MMSE
    Stable vitals
    Improvement of clinical symptoms

    Case Presentation:
    HPI: 62 y/o AAF presents to the ED with increasing
    confusion reported by spouse beginning yesterday night.
    Spouse also reports disorientation, lethargy, abdominal pain
    and constipation. Was discharged 4 days prior for CHF
    exacerbation

    PMHx:
    DM on OHG agent
    CHF, NYHA stage III
    HCV, HBV
    Portal HTN

    FHx: Non significant
    Case Presentation, cont:
    SHx
    Married 30 years, previous sex worker, previous alcohol
    dependent, clean 3 years

    Medications
    Gliprimide 3mg PO OD
    Meformin 500mg PO BID
    Furosemide 40mg PO OD
    Lactulose 30mL PO TID
    ED
    Vitals:
    RR: 22 BP: 135/78 P: 75 bpm T: 36.2
    Labs:
    Na: 144 K 4.1 Cr: 100 Glu: 12.1 Alb: 22
    AST: 100 ALT: 69 Bili: 7
    CK: 2468 Troponin: 1.6 GGT: 92
    Physical Exam:
    Gen: Disoriented, Confused, Sleep, Easily woken
    Skin: No rash, no jaundice
    CVS: RRR no G/R/M, pulse equal B
    Pulm: B basilar crackles, no R/R
    Ab: distended, soft, hepatomegaly, mild ascites
    CNS: Flapping tremors bilaterally

    Assessment and Plan:
    Assessment: 62 y/o AAF discharged 4 days prior for CHF
    exacerbation presenting with stage III hepatic
    encephalopathy likely 2/2 furosemide d/c. History of
    portal HTN and HBV and HCV
    Plan:
    Labs:
    CBC, LFTs, aPTT, U&E. PCR HBV and HCV DNA
    Meds
    Furosemide 40 IV BID
    Lactulose 30 mL PO TID
    Lactulose enema 300 mL PR OD
    Ceftriaxone 2 g IV OD
    SSI

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