Decreased brain function - Liver disease, hepatic coma; encephalopathy - Dr.Rajneesh Jain

श्री आर के होमियोपैथी हॉस्पिटल ,सागवाड़ा डॉ रजनीश जैन BHMS, PGDHHM Limca Book Recored Holder 2009

Decreased brain function - liver disease Hepatic coma; Encephalopathy - hepatic; Hepatic encephalopathy; Portosystemic encephalopathy Decreased brain function occurs when the liver is unable to remove toxins from the blood. This is called hepatic encephalopathy (HE). This problem can happen suddenly or develop slowly over time. CausesAn important function of the liver is to make toxins in the body harmless. These substances can be made by the body (ammonia) or by substances you take (medications). When the liver is damaged, these "toxins" can accumulate in the bloodstream and affect the function of the nervous system. This can result in HE. HE can happen suddenly and you can get sick very quickly. Causes of HE may include: Hepatitis A or B infection (it is uncommon to have this condition)Blockage of blood supply to the liverPoisoning by various toxins or medicationsConstipationUpper gastrointestinal bleedingPeople with severe liver damage often suffer from HE. The end result of long-term liver damage is cirrhosis. Common causes of chronic liver disease are: Severe hepatitis B or C infectionAlcohol abuseAutoimmune hepatitisBile duct disordersCertain medicationsNon-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)Once your liver is damaged, episodes of declining brain function may be triggered by: Lack of body fluids (dehydration)Eating too much proteinLow levels of potassium or sodium in the bloodBleeding in the intestine, stomach, or food pipe (esophagus)InfectionKidney problemsLow levels of oxygen in the bodyShunt placement or complicationsSurgeryNarcotic pain or sedative medicationsDisorders that look similar to HE may include: Alcohol intoxicationAlcohol addictionBleeding inside the skull (subdural hematoma)Brain disorder caused by vitamin B1 deficiency (Wernicke-Korsakoff syndrome)In some cases, HE is a short-term problem that can be cured. It can also occur as part of a long-term (chronic) problem caused by liver disease that gets worse over time. SymptomsThe symptoms of HE are graded on a scale of grades 1 to 4. They may start gradually and get worse over time. Early symptoms may be mild and include: Breath with a musty or sweet smellChanges in sleep patternsChanges in thinkingMild confusionAmnesiaChanges in personality or moodPoor concentration and judgementDeterioration of handwriting or loss of other small hand movementsSevere symptoms may include: Unusual movements or shaking of the hands or armsAgitation, excitement or seizures (occur rarely)DisorientationDrowsiness or confusionChanges in behaviour or personalitySpeech is slow or sluggishPeople with HE may become unconscious, unresponsive and possibly go into a coma. These symptoms often cause people to be unable to care for themselves. Tests and investigationsSigns of changes in the nervous system may include: shaking of the hands ("flapping tremors" or asterixis) when trying to hold hands and raising the arms in front of the bodyproblems with thinking and mental functionsigns of liver disease, such as yellowing skin and eyes (jaundice) and fluid retention in the abdomen (ascites)bad-smelling breath and urineThese tests may include: complete blood count or hematocritCT scan or MRI to check for anemiadigestive function testsprothrombin timeserum ammonia levels in the bloodsodium levels in the bloodpotassium levels in the bloodBUN (blood urea nitrogen) and blood creatinine to see how the kidneys are workingTreatmentThe treatment of HE depends on the cause. If the changes in brain function are severe, hospitalization may be needed. Bleeding in the digestive tract must be stopped. Infections, kidney failure, and changes in sodium and potassium levels need to be treated. Medications are given to help lower ammonia levels and improve brain function. Medications given may include: Lactulose to prevent bacteria in the intestines from making ammonia. This can cause diarrhea. Neomycin and rifaximin also reduce the amount of ammonia made in the intestines. If HE improves while taking rifaximin, it should be continued indefinitely. You should avoid: Any sedatives, tranquilizers, and any other medication that is broken down by the liver Medications containing ammonium (including some antacids) Your healthcare provider may suggest other medications and treatments. These may have different outcomes. Outcome (Prognosis)The prognosis of HE depends on the management of the cause of HE. Chronic forms of the disorder often keep getting worse and come back. The prognosis is good in the first two stages of the disease. The prognosis is poor in the third and fourth stages. When to Contact a Medical ProfessionalIf you or people around you notice any problems with your mental state or nervous system functioning, contact your provider. This is important for people who already have liver disease. It can get worse quickly and become an emergency. PreventionTreating Liver Problems Diseases can be prevented by avoiding alcohol and intravenous drugs. Many liver disorders can be prevented.  @Dr.Rajneesh Jain