Tuesday, January 23, 2018

Hepatic encephalopathy

Hello Awesomites! :D

Long time.

Today we will be discussing the Treatment of Hepatic Encephalopathy.
I like this topic because of its integration with biochemistry.

-After stable: Identify and treat trigger of Encephalopathy.

-Nasogastric aspiration (in case of bleeding) and protection of airway with a endotracheal tube. Always prefer to give prophylaxis for SBP with Amoxiclav / Cephalosporin if GI bleed is the trigger.

-Avoid constipation and favour bowel emptying by bowel wash, enema or by lactulose (15-30ml 3 to 4 times daily) or lactitol.  
-Bowel sterilisation by neomycin 1 gm qid or ampicillin. Neomycin helps in decreasing ammonia production or its absorption from the bowel. 
-Avoid drugs, especially sedatives and diuretics. 
-Protein is restricted and vegetable based protein may be given. 
-IV mannitol as a fast drip for reducing cerebral oedema.

-Newer/ Experimental modalities:
Flumezanil (BDZ antagonist)


-It creates an acidic intestinal environment to prevent NH3 absorption.
-Promote growth of glycolytic bacteria rather than proteolytic bacteria.
-Increase GI motility.

* L-ornithine-L-aspartate (LOLA)

-Provide a urea cycle alternative substrate.

* Rifaximin
-The recommended dose is one 550 mg tablet taken orally two times a day. Poorly absorbed Antibiotic to alter GI microbes.

*Correct Hyponatremia,Hypoglycemia and Hypovolemia.

*Branched chain Amino acids in diet. (Leucine and isoleucine)

-When no response to standard treatment, portosystemic shunting is considered.
Liver transplant allocation can be determined by using the MELD and sodium level (MELD-NA) score.
MELD score consist of:-
-Bilirubin (Means how well my liver take up byproduct from blood)
-INR (Means synthesis function of liver)
-Creatinine (Hepatorenal syndrome)

I hope it helped.
I want to thank Antariksh for edits in this post. :))

-Upasana Y. :)

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