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:
Bromocriptine
Flumezanil (BDZ antagonist)
*LACTULOSE OR LACTILOL
-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. :)
