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Hepatic Encephalopathy

by Carlo Raj, MD
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    00:01 Hepatic Encalopathy Let's talk about how, when there is liver damage, that the brain is not being injured.

    00:08 The pranchoma, welcome to hepatic Encephalopathy.

    00:11 This is reversible decline in cognitive fucntion.

    00:15 Stop there.

    00:16 The fact that you can even find cognitive function to be reversible is quite interesting.

    00:22 And actually limits the number of diagnoses.

    00:26 Here, if you are able to take care of the liver, then you'll notice the decline of cognitive function improves.

    00:33 Believed to be due to bypass of toxins Meaning to say, that maybe your ammonia, mercaptans instead of being properly detoxified in the liver, ends up in your head.

    00:43 hepatic encalopathy asterixis Often precipitated by bleeding infection electrolyte disturbance Diagnosis is clinical supported by elevated ammonia levels.

    00:56 NH3.

    01:01 Clinical presentation. Grades, you have 0-4 by West Haven Criteria.

    01:06 Alterations of behavior to frank coma.

    01:08 Asterixis, hyperreflexia and fetor hepaticus.

    01:13 are clinical presentations that you want to keep in mind when reading a stem of a question and they want you to think along the lines that the liver is severely compromised.

    01:26 Management: Lactulose non-absorbable antibiotics-Lactulose.

    01:33 You treat the underlying exacerbating factors.

    01:36 Avoid narcotics and, sedatives.

    01:39 Airway protection for frank coma.

    01:41 Remember, your patient is already in a state of brain damage.

    01:45 And so, therefore by giving a patient a sedative, you're only making matters worse.

    01:49 Lactulose, bind perhaps the ammonia and then therefore, relieve some of the encephalopathy


    About the Lecture

    The lecture Hepatic Encephalopathy by Carlo Raj, MD is from the course Cirrhosis – Liver Diseases.


    Included Quiz Questions

    1. Use of benzodiazepine
    2. Use of lactulose
    3. Use of non-absorbent antibiotics
    4. Use of electrolytes
    5. Endotracheal intubation
    1. West Haven criteria
    2. Dukes grading system
    3. Clarke grading system
    4. Nuygen grading system
    5. MELD scoring system
    1. Hepatic encephalopathy is an irreversible condition.
    2. Regularly used antibiotics can worsen function.
    3. Lactulose is a treatment option.
    4. Mercaptans and ammonia bypass the blood-brain barrier.
    5. Hepatic encephalopathy is precipitated by bleeding.

    Author of lecture Hepatic Encephalopathy

     Carlo Raj, MD

    Carlo Raj, MD


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