Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
15 Cards in this Set
- Front
- Back
|
complication of surgically constructed portal-systemic shunts |
Hepatic Encephalopathy |
|
|
Avague, generally reversible, neuropsychiatric disorder (change in personality,cognition, motor function, and/or level of consciousness) which results when products that are usually metabolized by the liver escape into the systemic circulation. |
Hepatic Encephalopathy |
|
|
crosses the blood-brain barrier, results in up-regulation of astrocytic peripheral-type benzodiazepine receptors |
Ammonia |
|
|
the most potent stimulants of neurosteroid production |
astrocytic peripheral-type benzodiazepine receptors |
|
|
the major modulators of GABA(A), which results in cortical depression and hepatic encephalopathy |
Neurosteroids |
|
|
associations of 3 different types of Hepatic Encephalopathy: - Type A: - Type B: - Type C: |
Type A: Acute liver failure (cerebral edema) Type B: porto-systemic Bypass without intrinsic hepatocellular disease (don't really care about this one) Type C: CIRRHOSIS and porto-systemic shunting (toxin) |
|
|
treatment for type A hepatic encephalopathy |
liver transplant (do not need a liver transplant in type C) |
|
|
theonly cells in the brain that can metabolize ammonia |
Astrocytes Astrocytesare the only cells in the brain that can metabolize ammonia and, in hepaticencephalopathy, changes in the astrocytes are seen (Alzheimer’s type II astrocytosis). |
|
|
modified west haven HE staging system stage 1 - mental state: - neuro sings: stage 2 - mental state: - neuro sings: stage 3 - mental state: - neuro sings: stage 4 - mental state: - neuro sings: |
|
|
|
diagnosis of hepatic encephalopathy |
CLINICAL FINDING AND HISTORY number connection test slow dominant rhythm on EEG Ammonia had a POOR CORRELATION with diagnosis |
|
|
two things that you will see in alcohol withdrawal but not in hepatic encephalopathy |
1. diaphoresis 2. hallucinations! |
|
|
two things that you will see in hepatic encephalopathy but not in alcohol withdrawal |
1. clinical signs of chronic liver disease 2. fetor hepaticus |
|
|
"hallmark" in diagnosis of hepatic encephalopathy |
asterixis (aka liver flap) not specific to hepatic encephalopathy |
|
|
treatment of Hepatic Encephalopathy |
Identify and treat precipitating factor Lactulose (adjust to 2-3 bowel movements/day) (rifamixin is a more expensive 2nd line option) protein restriction (not beneficial) |
|
|
mechanism of action of lactulose in treatment of HE |
gut acidification to decrease NH3 absorption traps nitrogen in stool by promoting incorporation in colonic bacteria for removal |
