Hepatic Encephalopathy Essay

Introduction Upper gastrointestinal bleeding can be manifested with hematemesis, melena or hematochezia. Acute bleeding due to gastroesophageal varices in cirrhotic patients is associated with higher morbidity, mortality rates as well as development of life-threatening complications. This bleeding significantly increase protein concentration in the bowel which results in increased ammonia production by colonic bacteria and precipitation of development of hepatic encephalopathy [1]. Hepatic encephalopathy, a neurological dysfunction disorder including a wide spectrum of clinical symptoms and signs with different grades ranging from minimal abnormalities in neuropsychological function to coma [2]. Hyper ammonemia causes neurotransmitter …show more content…
Grading of hepatic encephalopathy was according to West Haven Grading System [7]:
• Grade 0 - Minimal hepatic encephalopathy (subclinical hepatic encephalopathy); minimal abnormalities in memory, concentration, coordination and intellectual function and absence of flapping tremors.
• Grade 1 - minimal lack of awareness; defect in addition or subtraction; sleep abnormalities (hypersomnia or insomnia or inversion of sleep pattern); emotional abnormalities (euphoria or depression), irritability; mild confusion.
• Grade 2 - Lethargic or apathetic state; personality changes; disorientation of time; abnormal behavior; slurred speech; appearance of asterixis; drowsiness, major abnormalities in ability to do mental tasks.
• Grade 3 - Somnolence but patient can be aroused; marked confusion; inability to perform any mental tasks; disorientation for time and place; memory defect; occasional fits and incomprehensible