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Hepatic Encephalopathy

 Syn. Encephalopathies, Hepatocerebral , Portosystemic encephalopathy , Portal Systemic Encephalopathy

Signs & Symptoms

 Seizures #Hepatic_encephalopathy_Grade4
Note: due to increased intracranial pressure
Ref: Uptodate [ Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis]
Pupillary changes #Hepatic_encephalopathy_Grade4
Note: due to increased intracranial pressure
Ref: Uptodate [ Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis]
Increased intracranial pressure #Hepatic_encephalopathy_Grade4
Note: due to Cerebral edema
Ref: Uptodate [ Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis]
Cerebral edema #Hepatic_encephalopathy_Grade4
Ref: Uptodate [ Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis]

Physical Examination

 Pupils progress from normal response #Hepatic_encephalopathy_Grade1
Ref: Uptodate [ Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis]
Positive earlier Stroop Color Word Test
Ref: Cecil [ 464]
Positive Portosystemic Encephalopathy Syndrome Test
Ref: Cecil [ 464]

Lab / Serology

 Evidence of hepatic biochemical and synthetic dysfunction
Note: due to portal hypertension, due to diuretics
Ref: Uptodate [ Clinical manifestations and diagnosis of hepatic encephalopathy]
Hyponatremia
Note: due to portal hypertension, due to diuretics
Ref: Uptodate [ Clinical manifestations and diagnosis of hepatic encephalopathy]
Elevated ammonia level
Note: due to impaired liver function, arterial ammonia concentration provides a more accurate assessment, correlation between severity of liver disease and height of ammonia levels is often poor
Ref: Uptodate [ Clinical manifestations and diagnosis of hepatic encephalopathy] Harrison [ 2413] Cecil [ 463]

Imagin Study

 Normal EEG #Hepatic_encephalopathy_Grade1
Ref: Uptodate [ Alcoholic hepatitis: Clinical manifestations and diagnosis]
Abnormal EEG #Hepatic_encephalopathy_Grade2 #Hepatic_encephalopathy_Grade3 #Hepatic_encephalopathy_Grade4
Ref: Uptodate [ Alcoholic hepatitis: Clinical manifestations and diagnosis]

Complication

Risk Factors

 Acute liver failure
Ref: Unknown [ 0]
Chronic liver disease
Ref: Unknown [ 0]
Portal hypertension
Ref: Unknown [ 0]

Cause

 Caused by drug overdose
Ref: Cecil [ 464]
Caused by Azotemia
Note: due to diuretics
Ref: Cecil [ 464]
Caused by Deterioration in hepatic function
Ref: Cecil [ 464]

Other