Hepatic Encephalopathy

Complex of symptoms of disruption of the centralnervous system, i.e., psychoneurological disorders in people suffering from hepatic insufficiency or cirrhosis of the liver, is called hepatic encephalopathy. In the presence of this disease, metabolic reversible encephalopathy, irreversible chronic brain structure disorders and edema can occur.

Diagnosis of "hepatic encephalopathy" is madeabout 80% of patients with cirrhosis of a different etiology, and about 20% of patients who underwent surgery for the purpose of forming portosystemic shunting, as well as patients suffering from liver failure.

The main reasons for the development of liver failure, the consequence of which is hepatic encephalopathy, are:

- diffuse lesions of the liver (liver cirrhosis, chronic and acute hepatitis);

- narrowing (obturation) of bile ducts;

- the effect on the liver of various poisonous substances (the use of poisonous fungi, certain medicines and toxic substances);

- infectious diseases;

- extensive injuries or burns;

- Acute cholangitis;

- septic, as well as purulent diseases;

- thrombosis of the portal hepatic vein.

The clinical classification distinguishes between minimal hepatic encephalopathy, episodic and persistent. In addition, there are several stages of the disease:

- zero (latent) stage - absence of clinical symptoms,

- the first stage - there are disturbances in the rhythm of sleep,

- the second stage - disorientation manifests itself in time,

- the third stage - the presence of a stop and disorientation in space,

the fourth stage is a coma.

Hepatic encephalopathy caused by acutepathology of the liver, for example, acute hepatitis, and encephalopathy, which arose on the basis of chronic liver disease - cirrhosis, differ in the history, laboratory tests and complete clinical examination. In acute hepatitis, hepatic encephalopathy syndromes are usually more pronounced and develop faster than with liver cirrhosis.

Hepatic encephalopathy: symptoms

- Irritability, loss of interest in relatives, childishness and other personality changes;

- sleep disorder with impaired consciousness;

- monotony of voice, slowness of speech, etc .;

- the presence of a "liver" odor from the mouth;

- the presence of a "clapping" tremor;

- fluid in the abdominal cavity (ascites);

- jaundice and liver sprouts on the skin;

- black tarry stools and vomiting with blood.

The main instrumental methods, with the help ofwhich are diagnosed with hepatic encephalopathy, are: ultrasound of the abdominal cavity, endoscopy of the stomach, esophagus and electroencephalography. Laboratory methods such as collection of blood tests (general, biochemical, for poison, alcohol and ammonia levels), urine and feces are also used. In addition, psychometric testing of patients with the initial stages of the disease is carried out.

Hepatic encephalopathy: treatment

Treatment of such a disease, as hepatic encephalopathy, is a step, in which three main directions are distinguished:

1. Detection and subsequent elimination of factors that contributed to the development of hepatic encephalopathy.
2. Carry out activities aimed atreduction of the formation of various toxic products and their metabolites. And also the carrying out of measures, including reduction of the number of food proteins, their modification, normalization of the intestinal environment and intestinal microflora, as well as stimulation of emptying of the intestine.
3. The use of drugs that modify the ratio of neurotransmitters.

In addition, patients are recommended to adhere to a special diet that excludes hot and fatty foods, as well as alcohol.