ENCEPHALOPATHY

ENCEPHALOPATHYDISORDER OF CEREBRAL FUNCTION ==> Inflammation (-)DIGESTIVE TRACT1. Hepatic Encephalopathy2. Kernicterus3. Reye Syndrome4. Dehydration +disorder of consciousness5. Hypo/hypernatremia severe hypophosphatemia

GE + SEVERE DEHYDRATIONCIRCULATORY DISTURBANCESOXYGENATIONCONSCIOUSNESSGE+SEVERE DEHYDRATION+ENCEPHALOPATHYCOMA SHOCK

P< 1 mg %Energy Dysfunction of leucocytes &thrombocytesRBCRhabdomyolisisO2 delivery Cerebral Anoxia

KERNICTERUS= BILIRUBIN ENCEPHALOPATHY Unconsciousness Spasme Convulsion Mortality 75% Recovery- Blind - Deafness - Neuromusc. Incoord. (chorea athetosis)

EXCHANGE TRANSFUSION ==> UNCONJUG. BILIRUBIN > 20 mg %Th2. PHOTOTHERAPY3. PHENOBARBITAL4. INHIBITION OF ABSORPTION5. TIN PROTOPORFIRININHIBITION OF BILIVERDIN TO BILIRUBIN6. SUPPORTIVE

HEPATIC ENCEPHALOPATHY= LIVER FAILURE= HEPATOCELLULER FAILURE= HEPATOCYTIC FAILURE= GAGAL HATI HEPATIC COMA PORTO SYSTEMIC ENCEPH FULMINANT 2 WEEKS

SUBFULMINANT 2-8 WEEKS

CLINICAL GRADING OF HEPATIC ENCEPHALOPATHYI. CONFUSEDII.DROWSYIII.STUPOROUSIV.- COMA

- DEEP COMAHEPATIC COMA

gutHepatic V. portal v. Inferior v. cavaSystemicliverPorto systemic encephelopathy

LIVER FAILUREENCEPHALOPATHYCOAGULOPATHYDYSFUNCTIONINTRAHEPATICMETABOLISMHALLMARK

VENTILATIONWATER & ELECTROLYTES3. COAGULOPATHY:- Vitamin K- Transfusion : Fresh Frozen Plasma 4. BLOOD AMMONIA (NH3) :- lactulose- neomycine NephrotoxicREDUCING INTRACRANIAL PRESSURE :- cerebral edem : steroid, mannitol, etc.- hypokarbia Cerebral Blood Flow MONITORED CLOSELY FOR INFECTION HEPATOTOXIC DRUGS WITHDRAWN : - eg : SedativeTHERAPY :

BLOOD NH3ENCEPHALOPATHYFATTY DEGENERATIONHYPOGLYCEMIAMitochondrial dysfunctionACUTESALICYLIC ACIDREYE SYNDROME

1. CONTROL OF INTRACRANIAL PRESSURE Th2. WATER & ELECTROLYTES3. ADEQUATE OXYGENATION4. CONTROL OF HYPOGLICEMIA5. COAGULOPATHY IS MANAGED6. EXCHANGE TRANSFUSION

GASTROINTESTINAL HEMORRHAGE

GI BLEEDINGOUTIN-BLOOD DISORDERS : LEUKEMIA-SYSTEMIC- RUPTURE OF THE AORTABLOOD PER OSBLOOD PER ANUMHEMATEMESISGUT

HEMATEMESISINGESTIONDIGESTIVE TRACTINFANTSCHILDREN-NIPPLESHEMORRHAGIC DISEASE OF THE NEWBORN-INGESTION OFMATERNAL BLOOD (MATERNAL SWALLOWED BLOOD SYNDR.)

APT DOWNEY TESTEPISTAXIS- MUCOSAL LESION- VARICEAL BLEEDING

NEW BORNHb FHb AHb A250-90 %ALKALI RESISTENT

HEMATEMESISMUCOSAL LESIONPORTAL HYPERTENSIONESOPHAGEAL VARICESPEPTIC ULCERGASTRITIS

DRUGS- SALICYLIC ACID

PEPTIC ULCERBREAKDOWN IN BARRIERPROLONGED EXCESS ACIDINFECTION

H. PYLORI

H2 RECEPTORGASTRIN RECEPTORMUSCARINIC RECEPTORADENYLCYCLASEc AMPPROTEINKINASENa K ATP aseHCLZOLLINGER ELLISON SYNDR. NON B ISLET CELLGASTRINHISTAMINPROSTAGLANDIN(-)ACETYLCHOLINE

TH/1. MUCOSAL PROTECTION : SUCRALFATE2. ACID SECRETION3. NEUTRALIZED ACID ANTACIDE4. ERADICATION OF H. PYLORI - METRONIDAZOLE - CLARITHROMYCIN - OMEPRAZOLE2 WEEKS

ACID SECRETIONH2 RECEPTOR BLOCKER : CIMETIDINE RANITIDINE 2. PROTON PUMP INHIBITOR : OMEPRASOLE3. PROSTAGLANDIN SYNTHETASE: MISOPROSTOL 4. ANTICHOLINERGIC : PIRENZEPINE

INFECTION OF H. PYLORI1. INVASIVE TISSUE MICROSCOPICCULTUREUREA TEST2. NONINVASIVEUREA BREATH TESTSEROLOGY : IgG

BLEEDING PER ANUMOCCULTOVERTHEMOCCULT TESTMELENAHEMATOCHEZIA

*MaterialsHeme proteinHydrogen peroxidaseColorless guaiacBlue quinone

HEMATOCHEZIAWITH DIARRHOEAWITHOUT DIARRHOEAWITHOUT STOOLSDYSENTERYSYNDROME- ANAL FISSURE- RECTAL POLYPINVAGINATION

DYSENTERY SINDROME = BLOODY DIARRHOEA 1. DYSENTERY- BACILLARY- AMOEBIC2. Enterocolitis- Cows milk allergy3. Trichuriasis4. Others- Entero invasive E coli- C. jejuni