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Hepatic EncephalopathyHepatic Encephalopathy – General InformationHepatic Encephalopathy, also known as hepatoencephalopathy, is considered a reversible neuro-psychiatric condition which usually consists of liver failure, and can be chronic, such as cirrhosis, or acute. Generally, this kind of condition is diagnosed only after excluding other more common neurological, psychiatric, infectious and metabolic diseases. In most of the cases, if the liver does not function properly, the toxic substances that are normally destroyed by the liver accumulate in the patient’s blood stream, which eventually affect the brain cells function. The disease can also cause portal hypertension, which can affect the liver’s function of filtering the blood entering the intestines, which can also allow the toxic substances to get directly to the patient’s brain without being purified or modified. The main signs and symptoms of the Hepatic Encephalopathy disease can include impaired cognition, a flapping tremor, also known as asterixis, and a decreased level of consciousness including coma, in this case known as hepatic coma. The main causes of developing this disease are infections. There are cases in which the patient developed the condition after suffering from another disease that has affected his ascites, a disease called spontaneous bacterial peritonitis. There are also some cases in which the condition has developed from reduced protein diets. The low protein diet is usually administered in certain cases, but doctors can also interdict the consumption of proteins, which can lead to the appearance of the hepatic condition. If the disease is left untreated or is treated improperly, it can lead to the appearance of more severe complications such as cerebral edema, or even the death of the individual.Hepatic Encephalopathy – SymptomsThe main symptom of the Hepatic Encephalopathy disease is that the patient tends to sleep during the day and stay awake at night. The disease can also cause, in an early stage, impairment in spatial perception. Another significant sign of the Hepatic Encephalopathy disease is the patient’s difficulty in drawing or copying simple images such as a cube, star or clock. The disease is diagnosed by applying a test, called trail test or numbers connecting test, which consists in connecting a number of dots on a sheet of paper. Gradually, the disease can cause, after the changed level of consciousness, the presence of asterixis. The symptoms can be detected by having the individual hold out his or her arms and hands while cocking his wrists back. If the patient does this non-synchronized or has an intermittent flapping motion, he presents the asterixis condition (not specific for the Hepatic Encephalopathy disease). In advanced stages of the disease the most common signs and symptoms that appear are hyponatremia, which can be a sign of advanced cirrhosis, hypokalemia, alkalosis, dehydration, hypoglycemia, also a sign of cirrhosis, and mild renal failure. Another sign of the disease is stomach or small intestine bleeding, which appears in rare cases. There are cases in which the patient does not experience obvious signs and symptoms, and the disease is discovered when the patient gets into hepatic coma. If the coma is not treated or treated improperly, the disease can progress and cause the appearance of cerebral edema, and eventually, the death of the individual.Hepatic Encephalopathy – TreatmentIn most of the cases, the Hepatic Encephalopathy disease can be treated with certain treatment options such as a reduced protein intake, correction of hypokalemia, lactulose, antibiotics, Rifaximin, and benzodiazepine receptor antagonists. Usually, specialists say that excessive protein intake can lead to an increased amount of ammonia, which can cause severe liver dysfunction, and eventually, will accumulate and worsen the disease status. Due to the fact that several large protein loads (or gastrointestinal hemorrhage, because the blood contains large quantities of proteins) are thought to worsen the state of the disease, a full protein restriction for patients who suffer from severe liver affections may be recommended. However, if the patient’s protein diet is reduced too much, the liver disease can lead to the appearance of certain complications such as malnutrition and a negative nitrogen balance. To treat Hepatic Encephalopathy, the doctor can also correct the patient’s hypokalemia, because it increases renal ammonia secretion. This can also ease the conversion of ammonium into ammonia, which can get to the patient’s brain. Hepatic Encephalopathy can also be treated by using lactulose, which is a medicine that usually causes diarrhea, but it prolongs the time available for the patient’s intestinal bacteria to metabolize protein into ammonia. The medicine also acidifies the environment in the lumen of the bowel. Lactulose also ease the conversion of lumenal ammonia to ammonium, which is better absorbed into the blood stream. Usually, it is administered rectally, in doses of 300 ml syrup diluted in one litre of water which must be retained for one hour, and the patient must stay in a Trendelenburg position. Another way to treat Hepatic Encephalopathy is the use of antibiotics, which are given to kill the bacteria present in the bowel and to decrease the bacterial conversion of protein to ammonia or other toxic solutions. In most of the cases, the treatment trial with antibiotics is effective, but there is one antibiotic which is strictly contraindicated, the non-absorbable amino glycoside antibiotic. This antibiotic can further damage the patient’s health state, and in some cases ingestion of this medicine can lead to the development of several severe conditions such as renal failure and hearing loss. The antibiotic treatment option can also cause some side effects, which can be life threatening and appear as renal failure and portal hypertension. The most common antibiotics used to treat the disease are Neomycin and Metronidazole. To treat Hepatic Encephalopathy disease the doctors can also recommend a treatment trial with Rifaximin, prescribed as Xifaxan, which is a drug more tolerable than antibiotics. Generally, this kind of medicines is administered orally in 400 mg dose, three times a day for maximum effect. There are cases in which the lactulose treatment trial was more effective that the former. Please note that the cost of this drug may be higher than that of other medications. The benzodiazepine receptor antagonists can also be used to treat Hepatic Encephalopathy disease, and the most common type of this medicine is Flumazenil. This medicine is usually administered in two mg dose in ten minutes for maximum effect. |
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