PRECIPITATING FACTORS OF HEPATIC ENCEPHALOPATHY: EXPERIENCE AT PAKISTAN INSTITUTE OF MEDICAL SCIENCES ISLAMABAD.
AbstractBackground: Hepatic encephalopathy is an extra hepatic complication of impaired liver functionand is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liverdisease in the absence of other neurological disorders. There are numerous factors of hepaticencephalopathy. The main objective of this study was to analyse the precipitating factors ofhepatic encephalopathy in cases seen in Pakistan Institute of Medical Sciences Islamabad.Methods: Fifty admitted patients with acute or chronic liver diseases complicating to hepaticencephalopathy were probed into for precipitating factors, based on history, clinical examinationand laboratory methods from September 2005 to December 2005. The associated biochemicallaboratory data analysis and prognostic stratification through Child’s Pugh classification was alsodone. Results: Infection (44%), gastrointestinal bleeding (38%) and constipation (38%), stood outas the most common factors. Usage of drugs with ammonium salts, tranquilizers and large volumeparacentesis 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 importantprecipitating factors must be prevented and hospital funds, medicines and human efforts shouldlay emphasis, on these factors to decrease the incidence of hepatic encephalopathy. This alsoincludes effective control measures against rising cases of hepatitis C, as it is the leading cause ofliver cirrhosis in Pakistan.Key Words: Hepatic Encephalopathy, Liver cirrhosis, precipitating factors.
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