Hepatic Encephalopathy

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