6)<\/strong> physiologic stress (surgery)<\/p>\nBiochemistry<\/h4>\n in hepatic encephalopathy the following are increased –<\/p>\n
1)<\/strong> ammonia \n2)<\/strong> permeability of blood-brain barrier \n3)<\/strong> endogenous benzodiazepines \n4)<\/strong> GABA \n5)<\/strong> mercaptans (methionine byproducts) \n6)<\/strong> phenol \n7)<\/strong> short chain fatty acids \n8)<\/strong> octopamine (a false neurochemical transmitter secondary to abnormal amounts of branched-chain and aromatic amino acides)<\/p>\nTreatment<\/h4>\n 1)<\/strong> elimination of precipitating factor \n2)<\/strong> evacuation of blood from lower GI tract (via enemas\/laxatives) \n3)<\/strong> low-protein diet \n4)<\/strong> lactulose \n5)<\/strong> oral nonabsorbably antibiotics (neomycin) \n6)<\/strong> metronidazole \n7)<\/strong> refaximin \n8)<\/strong> barbituate coma in severe cases<\/p>\nTips for USMLE<\/h4>\n 1)<\/strong> not all hepatic encephalopathy patients have increased ammonia levels (and levels do not correspond to severity) \n2)<\/strong> asterixix occurs in other conditions (renal failure, hypercapnia, lead poisoning, drug overdose (especially the anticonvulsants)<\/p>\n","protected":false},"excerpt":{"rendered":"Pathophysiology of Hepatic Encephalopathy Hepatic encephalopathy is a: 1) neuropsychiatric disturbance caused by cirrhosis\/hepatocellular dysfunction and shunting of portal venous blood into the systemic system with bypass of the liver 2) exact mechanism is unknown – likely ammonia level is involved 3) typically follows a precipitating event (like GI bleeding or infection) in a stable […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[5126,63,27],"tags":[816,817,822,819,821,818,820],"yoast_head":"\n
Hepatic Encephalopathy - InsideSurgery Medical Information Blog<\/title>\n \n \n \n \n \n \n \n \n \n \n \n \n\t \n\t \n\t \n