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20 hepatic enchephalopathy

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HEPATIC ENCEPHALOPATHY GAO XIANG Department of Gastroenterology The First Affiliated Hospital
DEFINITION ,[object Object]
AETIOLOGY ,[object Object],[object Object],[object Object],Concensus in Hepatic Encephalopathy, WCOG, 2001; in press
Hepatic encephalopathy- A complication of cirrhosis of the liver 0 20 40 60 80 100 120 140 160 0 20 40 60 80 100 Probability of complications (%) Gines et al. Hepatology (1987) 7, 1:122-128 Months
Key questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PATHOGENETIC MECHANISM ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ammonia intoxication theory NH 3 NH 4 urea & H +
 
[object Object],[object Object],[object Object],[object Object],Amino acid metabolic imbalance
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],False neurotransmitter Colon: protein x ( Brain )
GABA/BZ receptor complex theory ,[object Object],[object Object],--- the use of benzodiazepine antagonist
CLINICAL MANIFESTATION
[object Object],[object Object],[object Object],[object Object],[object Object],Clinical features
[object Object],[object Object],[object Object],[object Object],(Cont).
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Clinical grading
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Con’t)
 
[object Object],[object Object],[object Object],[object Object],[object Object],Note
[object Object],[object Object],[object Object],[object Object],Investigation
DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
[object Object],[object Object],[object Object],[object Object],Diagnosis
[object Object],Differential diagnosis
TREATMENT
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Modify colonic flora, resulting in displacement of urease-containing bacteria with lactobacillus Cathartic effect Lower the colonic pH, resulting in the formation of nonabsorbable NH 4 from NH 3 in the colon
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object]
[object Object],[object Object]
PROGNOSIS ,[object Object],[object Object],[object Object],[object Object]
 

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20 hepatic enchephalopathy

  • 1. HEPATIC ENCEPHALOPATHY GAO XIANG Department of Gastroenterology The First Affiliated Hospital
  • 2.
  • 3.
  • 4. Hepatic encephalopathy- A complication of cirrhosis of the liver 0 20 40 60 80 100 120 140 160 0 20 40 60 80 100 Probability of complications (%) Gines et al. Hepatology (1987) 7, 1:122-128 Months
  • 5.
  • 6.
  • 7.
  • 8.  
  • 9.
  • 10.
  • 11.
  • 13.
  • 14.
  • 15.  
  • 16.
  • 17.
  • 18.  
  • 19.
  • 20.
  • 21. DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
  • 22.
  • 23.
  • 25.
  • 26.
  • 27. Modify colonic flora, resulting in displacement of urease-containing bacteria with lactobacillus Cathartic effect Lower the colonic pH, resulting in the formation of nonabsorbable NH 4 from NH 3 in the colon
  • 28.
  • 29.
  • 30.  
  • 31.
  • 32.
  • 33.
  • 34.