Hepatic encephalopathy
CC: confusion
Diagnosis:
Haptic encephalopathy
It is Clinical diagnosis
Symptoms ranging from personality change to coma
Supportive Examination findings:
Asterixis ( flapping hand tremor )
Causes:
Spontaneously
Or
Precipitated by infection, sedating medications, volume depletion, or gastrointestinal bleeding
What will you do ?
Check vitals, remember ABC
ICU consult
Treat and eliminate the causes ( infection, sedating medications, volume depletion, or gastrointestinal bleeding )
Lactulose enema tds
Lactulose po tds
Rule sepsis, do septic work up
Rifaximin 550 mg Po BD
• Ammonia is not used for diagnosis nor follow up
Target stool per day ?
3 to 5 stools per day
Tell me about classification of hepatic encephalopathy ?
Severity of encephalopathy:
Minimal
Grade 1
Grade 2
Grade 3
Grade 4
