PRECIPITATING FACTORS OF HEPATIC ENCEPHALOPATHY: EXPERIENCE AT PAKISTAN INSTITUTE OF MEDICAL SCIENCES ISLAMABAD.
Abstract
Background: Hepatic encephalopathy is an extra hepatic complication of impaired liver functionand is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver
disease in the absence of other neurological disorders. There are numerous factors of hepatic
encephalopathy. The main objective of this study was to analyse the precipitating factors of
hepatic encephalopathy in cases seen in Pakistan Institute of Medical Sciences Islamabad.
Methods: Fifty admitted patients with acute or chronic liver diseases complicating to hepatic
encephalopathy were probed into for precipitating factors, based on history, clinical examination
and laboratory methods from September 2005 to December 2005. The associated biochemical
laboratory data analysis and prognostic stratification through Child's Pugh classification was also
done. Results: Infection (44%), gastrointestinal bleeding (38%) and constipation (38%), stood out
as the most common factors. Usage of drugs with ammonium salts, tranquilizers and large volume
paracentesis were least common factors. Most patients were in grade III (52%), and grade IV
(22%), of hepatic encephalopathy. Other common associations were ascites (64%), Child's class C
(62%), hyponatremia (50%), low haemoglobin (70%), hepatitis C (62%), and high mortality rate
(30%). Conclusion: Infection, gastrointestinal bleeding and constipation being the most important
precipitating factors must be prevented and hospital funds, medicines and human efforts should
lay emphasis, on these factors to decrease the incidence of hepatic encephalopathy. This also
includes effective control measures against rising cases of hepatitis C, as it is the leading cause of
liver cirrhosis in Pakistan.
Key Words: Hepatic Encephalopathy, Liver cirrhosis, precipitating factors.
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