Hepatic encephalopathy: what is it, symptoms, treatment

In case of violation of the functional state of the liver, which is responsible for the disposal of some products of metabolism of various cells of the body, develops encephalopathy. It is quite a serious complication. Encephalopathy on the background of the decrease of the liver is the cause of severe violations of human consciousness and high frequency of fatal outcomes.

Hepatic encephalopathy – what is it?

The term «encephalopathy» defines a pathological condition of the brain cells (neurocity) as a result of exposure to various damaging factors. Hepatic encephalopathy is a consequence of toxic exposure to ammonia. He is in a large enough quantity is formed in the human colon due to the activity of the bacterial flora of the components of protein. Then enters the blood system of the portal vein, with a current which enters the liver cells (hepatocytes), where under the influence of enzymes (glutaminsintetaza) is converted into the amino acid glutamine. When there is insufficient functional activity of hepatocytes, ammonia in the liver neutralized and enters the bloodstream, enters neurocity, leading to their damage and partial destruction with the relevant manifestations of brain pathology.

The etiology (cause)

Encephalopathy of the liver develops as a result of 2 major groups of causes, which include:

  • The death of a large number of hepatocytes (gepatonekros) in severe viral hepatitis, toxic liver injury (poisoning with mushrooms, systematic use of large doses of alcohol, improper use of certain medicines in excess of their therapeutic dosage), ischemia (insufficient blood flow in the liver), severe infectious diseases.
  • Portosystemic shunting of blood – blood from the portal vein passes through the liver, and by the formation of vascular shunts is dumped directly into the systemic circulation. This condition develops when the cirrhosis of the liver (the gradual replacement of dead hepatocytes by connective tissue), which is a consequence of chronic diseases (chronic viral hepatitis, fatty degeneration, alcoholic hepatitis).
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    Regardless of the causes of hepatic encephalopathy, the mechanism of development and clinical manifestations are almost always the same.

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    Symptoms

    The main symptoms are changes in the higher nervous activity of man. These include personality changes (sharp decrease in self-criticism, loss of interest in loved ones, irritability), decreased intelligence and memory, as well as sleep disorders of consciousness (up to coma). For the disease characterized by a disturbance of motor function, which consists of ataxia (wobbly gait), tremors (shaking) hands. The specific feature is the appearance of liver bad breath. According to the severity of brain lesions and manifestations of disorders of higher nervous activity in clinical practice there are 4 stages of pathology:

    • Stage 1 (precoma) is practically not accompanied by severe clinical symptoms (patients report a slight headache, dizziness, intermittent nausea, nosebleeds). From the side of higher nervous activity it is possible to change the emotional sphere, manifested in fussiness, sudden mood swings.
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    • Stage 2 (somnolence) – clinically significant violation of the functional activity of the brain, characterized by the development of its oppression (periodic momentary loss of consciousness, confusion, pronounced sleep disorder characterized by insomnia at night and sleepiness during the day), changes in the emotional sphere, decreased intelligence, as well as the development of motor disorders (there are twitches of individual muscle groups).
    • Stage 3 (stupor) – developing stupor of the patient with a periodic excitation, motor, auditory hallucinations and delusions.
    • Stage 4 (coma) – severe impairment of the functional activity of the brain with a complete lack of consciousness and reflex responses to any stimuli.
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    When coma changes in the brain are irreversible, so bring a man from this state is almost impossible.

    The treatment of hepatic encephalopathy

    The main therapeutic activity when hepatic encephalopathy is the restoration of the functional activity of the liver to reduce the toxic effects on the brain with various drugs, the choice of which is dependent on the underlying pathology. Also required are measures to reduce intoxication and to reduce the concentration of ammonia in the blood. This is accomplished by using strict dietary advice and assigned detoxification therapy. To date, the methodology developed hardware for the purification of blood from metabolic products («artificial liver»).

    Diet for hepatic encephalopathy

    Regardless of the severity of violations of the functional state of the liver and brain necessarily performed dietary recommendations to reduce intake of animal proteins, thereby decreasing their bacterial cleavage in the colon. This diet implies the maximum limit meat (especially fatty varieties fried), smoked meats, pickles, marinades, avoiding alcohol. A preference for plant foods, dairy products (primarily included in the diet cottage cheese which has hepatoprotective properties), as well as dietary varieties of meat (beef, chicken) and fish.

    The treatment of hepatic encephalopathy is lengthy. It requires a disciplined approach on the part of the patient, especially in relation to the implementation of dietary recommendations.

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