Overview on Hepatic Encephalopathy

Abstract

Hepatic encephalopathy (HE) has appeared in the last years as serious, life threatening and debilitating complication of both persistent and episodic liver diseases. This review explores HE definition, pathogenesis, diagnosis and available treatment options. Overt HE is a major cause for hospitalization, readmission and even death in cirrhotic patients, while covert HE can affect negatively on patient quality of life, ability of driving and survival. Clinical manifestations of HE include cognitive function impairment and deteriorated psychometric motor functions. Diagnostic options for HE are varied and depend on the impairment degree and the acuity of clinical presentations of HE. Pathogenesis of HE is sophisticated and depends on several factors, however, ammonia is considered to play a critical role in HE pathophysiology. Management options of HE include controlling of precipitating factors, medical treatment and liver transplantation. Standard medical treatment of HE comprises non-absorbable disaccharides as lactulose and some antibiotics as rifaximin. Newer drugs that act on serum ammonia level have a vital role in management of HE, such as l-ornithine-l-aspartate, sodium phenylbutyrate and sodium benzoate.

Educational Nursing Program Implementation: It’s Effect on Hepatic Encephalopathy Severity among Patients with Liver Cirrhosis

“…HE is associated with a 23% survival rate after three years and a 42% survival rate after one year of follow-up. Furthermore, approximately 30% of patients who died to end-stage liver disease exhibited severe encephalopathy, which progressed to coma (Saber et al, 2019). There are many studies which have observed that both patients and caregivers have limited disease understanding and its management so it is hoped that structured nursing instructions that may lead to reduce patient's complications, hospital stay, nurse's workload and cost burden on the patients and society that are associated with complications management.…”

“…Hepatic encephalopathy (HE), which occurs in advanced liver disorders patients due to hepatic dysfunction, is broadly defined as a neuropsychiatric syndrome characterized by reversible brain function impairment. HE, which occurs in advanced liver disorders patients due to hepatic dysfunction, is broadly defined as a neuropsychiatric syndrome characterized by reversible brain function impairment (Saber et al, 2019). It is a complex neurological process worldwide and a reversible syndrome observed in advanced liver disease patients.…”

Assessment of Knowledge Regarding Hepatic Encephalopathy among Patients with Liver Cirrhosis

“…In the brain, NH3 crosses the blood-brain barrier and is metabolized in the astrocytes by glutamine syntheses, which converts NH3 and glutamate to glutamine. Glutamine accumulation in astrocytes produce an osmotic gradient, which results in swelling of astrocytes and creation of reactive oxygen species, that in turn participating in the cerebral impairment that is seen in HE (Saber et al, 2019). Hepatic encephalopathy is generally manifested by several neuropsychiatric disturbances such as psychomotor impairment, deteriorated memory, shortened reaction time, declined awareness, sensory abnormalities and weakened concentration.…”

“…Hepatic encephalopathy is generally manifested by several neuropsychiatric disturbances such as psychomotor impairment, deteriorated memory, shortened reaction time, declined awareness, sensory abnormalities and weakened concentration. It is also accompanied by personality features changes, intellectual deterioration, and a diminished consciousness (Saber et al, 2019& Shawcross et al, 2016. Knowledge regarding to hepatic encephalopathy has a vital role in prevention of hepatic encephalopathy episodes that include educating the patient and the family about the disorder, its progression and potential complications.…”

“…So, the current study's purpose was to assess knowledge regarding hepatic encephalopathy among patients with liver cirrhosis to minimize occurrence of hepatic encephalopathy. Moreover, about thirty percent of patients who died due to end-stage liver disease undergo prominent encephalopathy, reaching to coma (Saber et al, 2019). It is hoped that assessment of patients' knowledge may lead to reduce patient's complications, hospital stay, nurse's workload and cost burden on the patients and society that are associated with complications management by establishment of educational programs for cirrhotic patients regarding hepatic encephalopathy, its prevention and the prognosis of cirrhotic patients following episode of HE.…”