20. Precipitating factors of hepatic encephalopathy in liver cirrhosis and their impact on hospital stay and mortality—our center experience

2018 ◽  
Vol 8 ◽  
pp. S60-S61 ◽  
Author(s):  
Sachin K. Dhande ◽  
K. Caroline Selvi ◽  
A. Anand ◽  
A. Aravind ◽  
K. Premkumar ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Hospital Stay ◽  
Precipitating Factors

scholarly journals Hepatic Encephalopathy in Liver Cirrhosis: Precipitating factor and Outcome

2019 ◽  
Vol 17 (1) ◽  
pp. 2-4
Author(s):  
Dipendra Khadka ◽  
Dipendra Khadka ◽  
Anil Shrestha ◽  
S. D. Bassi ◽  
Binus Bhandari
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Hospital Stay ◽  
Early Recognition ◽  
Wide Spectrum ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Precipitating Factors ◽  
Cross Sectional ◽  
Precipitating Factor

Introduction: Hepatic encephalopathy, one of the major decompensating events of liver cirrhosis manifest as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma. The main aim of this study was to determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Methods: A hospital based cross-sectional study carried out in the Department of Medicine, Nepalgunj Medical College, Kohalpur from September 2018 to May 2019. Patients of liver cirrhosis with signs and symptoms of hepatic encephalopathy (HE) were enrolled in the study. Detailed history was taken with patients or patient's visitor regarding precipitating factors. Child Turcotte Pugh (CTP) class was used for assessing liver disease severity and West Haven classification was used for grading of hepatic encephalopathy. Results: Total patients of hepatic encephalopathy studied were 150. Among which, 114 (76%) were male and 36 (24%) were female. Mean age was 45 ± 11years. Common precipitating factors for hepatic encephalopathy identified were constipation 25.3%, Upper gastrointestinal bleed (9.3%), Spontaneous bacterial peritonitis (8%). No identifiable factor was observed in 6.7% cases. Significant relationship was noted with CTP class and grading of Hepatic encephalopathy. Hospital stay was also found longer (≥5 days) among patients having more than one precipitating factor. Conclusions: Early recognition of precipitants and patient education is very crucial in the management of hepatic encephalopathy. Patients having ≥ 2 precipitating factor had longer hospital stay and higher grade of hepatic encephalopathy.

scholarly journals Precipitating Factors and Treatment Outcomes of Hepatic Encephalopathy in Liver Cirrhosis

Cureus ◽  
2019 ◽  
Author(s):  
Nandu S Poudyal ◽  
Sitaram Chaudhary ◽  
Sudhamshu KC ◽  
Bidhan N Paudel ◽  
Bhupendra K Basnet ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Treatment Outcomes ◽  
Precipitating Factors

Study of clinical features and precipitating factors of hepatic encephalopathy in patients with liver cirrhosis

2019 ◽  
Vol 12 (3) ◽  
pp. 142-147
Author(s):  
Shripad Vithalrao Dhanorkar ◽  
◽  
Rajabhau Vishwanathrao Galande (Patil) ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Clinical Features ◽  
Precipitating Factors

scholarly journals Detection of Precipitating Factors of Hepatic Encephalopathy in Chronic Liver Disease Patients in a Tertiary Hospital

2017 ◽  
Vol 19 (1) ◽  
pp. 10-14
Author(s):  
Md Asadul Kabir ◽  
Jewel Chowdhury ◽  
Md Anwarul Bari ◽  
Kazi Bodruddoza ◽  
Asim Kumer Saha ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Disease Patient ◽  
Chronic Liver ◽  
Control Measures ◽  
Electrolyte Imbalance ◽  
Precipitating Factors

Background: Chronic liver disease (CLD) is commonly encountered by physicians in hospital practice. Hepatic encephalopathy is a serious complication of chronic liver disease, arising most commonly in those with advanced liver cirrhosis. In patients with otherwise stable cirrhosis, hepatic encephalopathy often follows clearly identifiable precipitating events. The aim of study is to find out the precipitating factors and their frequency in patients of CLD presenting with hepatic encephalopathy to prevent mortality and morbidity.Methods: This descriptive observational study was carried out to identify the precipitating factors and their frequency among 50 cases of diagnosed chronic liver disease presenting with hepatic encephalopathy at department of Medicine of Sir Salimullah Medical College & Mitford hospital, Dhaka from July 2012 to December 2012 for a period of 6 months.Results: Among 50 patients, 36 patients (72%) were male, 14 (28%) were female. Study showed that age frequency 14 (28%) were from 41-50 years and 08 (16%) were from 51-60 years, 12 (24%) >60 years of age. Out of 50 patients, the etiology of liver cirrhosis was hepatitis B virus in 28 (56%), hepatitis C virus in 4 (8%), both Hepatitis B & C in 02 (4%) Among 50 patients, 13 (26%)were in Grade-3 and 11 (22%) in Grade-2 Hepatic encephalopathy. According to Child-Pugh scoring 16 (32%) in Grade-C & 09 (18%) in Grade-B. The most common precipitating factors were identified as GI bleeding (28%), Infection (26%), mixed (16%) & unknown (20%). In this study, mortality rate was 32% most of the patients from Child-Pugh class-C.Conclusions: Commonest precipitating factors of hepatic encephalopathy in this study were upper G.I. bleeding, infection, mixed factor and electrolyte imbalance. To prevent hepatic encephalopathy caution must be exercised in putting chronic liver disease patient on diuretics. Early and effective infection control measures and better hygienic conditions in government hospitals are needed to be maintained.J MEDICINE Jan 2018; 19 (1) : 10-14

scholarly journals Innumerable cerebral microbleeds in hepatitis B virus-related decompensated liver cirrhosis: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chi Hyuk Oh ◽  
Jin San Lee
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Brain Mri ◽  
Cerebral Microbleeds ◽  
Amyloid Angiopathy ◽  
Decompensated Liver Cirrhosis ◽  
B Virus ◽  
The Brain

Abstract Background Cerebral microbleeds (CMBs) are small, rounded, dark-signal lesions on brain MRI that represent cerebral hemosiderin deposits resulting from prior microhemorrhages and are neuroimaging biomarkers of cerebral amyloid angiopathy (CAA). Here, we report a case of innumerable CMBs in a patient with hepatic encephalopathy underlying decompensated liver cirrhosis. Case presentation An 83-year-old woman diagnosed with hepatitis B virus-related liver cirrhosis 40 years before was referred to our neurology clinic for progressive disorientation of time and place, personality changes, and confusion with somnolence over 2 weeks. Based on the laboratory, neuroimaging, and electrophysiological findings, we diagnosed the patient with hepatic encephalopathy, and her symptoms recovered within 12 h after proper medical management. Brain MRI showed innumerable CMBs in the bilateral frontal, parietal, temporal, and occipital lobes. Since the distribution of CMBs in the patient was mainly corticosubcortical and predominantly in the posterior cortical regions, and the apolipoprotein E genotype was ε4/ε4, we speculated that CAA and hepatic encephalopathy coexisted in this patient. Conclusions We suggest that severe liver dysfunction associated with long-term decompensated liver cirrhosis may be related to an increased number of CMBs in the brain. Our findings indicate that decompensated liver cirrhosis may be a risk factor for the development of CMBs and corroborate a link between the liver and the brain.

PRECIPITATING FACTORS AND EFFICACY OF COMBINING LACTULOSE PLUS RIFAXIMIN IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY DUE TO CIRRHOSIS AT CHO RAY HOSPITAL

2020 ◽  
pp. 63-68
Author(s):  
Phat Ho Tan ◽  
Tam Vu Thi Minh ◽  
Trong Huynh Nguyen Dang ◽  
Phuong Tran Nhat Thi Anh ◽  
Ngan Tran Thi Kim ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Gastrointestinal Bleeding ◽  
Clinical Symptoms ◽  
Controlled Trial ◽  
P Value ◽  
Precipitating Factors ◽  
Overt Hepatic Encephalopathy ◽  
Group A ◽  
Group B ◽  
Male To Female

Background: Hepatic encephalopathy is an important evidence that confirms impairment of liver function, may occur in about 40% of cirrhotics. Data about efficacy of rifaximin plus lactulose in the treatment of Vietnamese patients was still limited. This study aimed to determine the precipitating factors and to access the efficacy of lactulose plus rifaximin in overt hepatic encephalopathy. Patients and Methods: The prospective single-blind randomized controlled trial, 43 cirrhotics with overt hepatic encephalopathy without portal systemic shunting addmitted to gastroenterology department of Cho Ray Hospital from March 2019 to August 2019, were randomized into two groups (group A lactulose plus rifaximin 1.100 mg/day, n = 21; and group B only lactulose; n = 22). All patients were recorded for onset factors, clinical characteristics and assessing the recovery of hepatic encephalopathy. Results: The mean age of patients in this study was 54.8 ± 12.1 years (the ratio of male to female patients is 4.38 : 1). The leading cause of cirrhosis was alcohol (39.5%). The most common clinical symptoms were jaundice (83.7%), spider naevi (41.9%) and ascites (37.2%). The most common triggers were infection (51.2%), gastrointestinal bleeding (37.2%) and constipation (25.6%). The percentage of patients with complete improvement after treatment with lactulose plus rifaximin was 81% compared to 63.6% in the lactulose-treated patients only (95% CI: 0.539 - 1.147, p value = 0.206). Conclusion: Our data revealed that common triggers of hepatic encephalopathy were infections, gastrointestinal bleeding and constipation. The combination of lactulose plus rifaximin was more effective than rifaximin alone in the treatment of overt hepatic encephalopathy. Key words: hepatic encephalopathy, precipitating factor, lactulose, rifaximin

scholarly journals Role of Rifaximin for the Treatment of Hepatic Encephalopathy in Chronic Liver Disease

2017 ◽  
Vol 7 (3) ◽  
pp. 205-211
Author(s):  
Ranjit Kumar Paul ◽  
Indrajit Kumar Datta ◽  
Habib Ahmed ◽  
Mohammad Reazul Karim ◽  
Md Nazmul Haque ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Hospital Stay ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Controlled Study ◽  
End Of Treatment ◽  
Group A ◽  
Group B ◽  
Ctp Score

Background: Hepatic encephalopathy (HE) is a common problem in patients with chronic liver disease (CLD) and is characterized by diminished mentation and neuromuscular abnormalities. Rifaximin has been reported to be effective for the treatment of hepatic encephalopathy (HE) in Europe and other countries. It is unknown whether rifaximin is effective for the treatment of hepatic encephalopathy in Bangladeshi patients.Methods: A prospective, randomized, single blind, placebo controlled study was conducted to evaluate the efficacy of rifaximin among patients with cirrhosis of liver with hepatic encephalopathy. A total sixty patients of HE fulfilling inclusion criteria were randomly enrolled among those admitted under Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD) department of BIRDEM General Hospital during August 2012 to April 2013. Patients were divided into two groups: group A (receiving Tab. rifaximin with lactulose), the total number of patients were 31(51.7%) and group B (receiving placebo with lactulose), it was 29(48.3%). Enrolled patients were followed up for 10 days or up to discharge from the hospital or death. At enrollment and at the end of treatment, gradation of HE and estimation of portosystemic encephalopathy (PSE) index was done.Results: In this study between two groups, mean age difference (p=0.404), gender difference (p=0.668) and CLD duration difference (p=0.555) were not statistically significant between two groups. At enrollment, prognostic scores e.g. Child-Turcotte-Pugh (CTP) score (p=0.489) and PSE index (p=0.934) were not significantly different between two groups. At the end of treatment, group A patients showed significantly lower HE grade (P=0.045) and PSE index (P<0.05) than group B. CTP score (p=0.552) was also lower in rifaximin treated group than placebo group but no significant difference was observed. The mean duration of hospital stay was significantly lower in group A than group B (p<0.05).Conclusions: Hepatic encephalopathy patients treated with rifaximin plus lactulose have better outcome and less hospital stay than those treated with placebo plus lactulose.Birdem Med J 2017; 7(3): 205-211

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