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05/01/2023
LIVER DISEASE AND HEPATIC ENCEPHALOPATHY
SYMPOSIUM THEME: MATERNAL MENTAL HEALTH,
OUR COLLECTIVE RESPONSIBILITY
Ms D. ZHOU and Mr. C MUSARURWAEmail: [email protected]: [email protected]
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INTRODUCTIONHepatic Encephalopathy (HE) a condition of brain and nervous system damage caused by hepatic dysfunction due to deterioration of brain function that occurs because toxic substances normally removed by the liver build up in the blood and reach the brain
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INTRODUCTIONThe global prevalence of minimal hepatic encephalopathy in patients with cirrhosis ranges between 30% - 84% Approximately 30% of patients dying of end-stage liver disease experience significant hepatic encephalopathy, as they approach coma Prevalence of overt hepatic encephalopathy was 0.4% in Tanzania (2009-2015) Data is lacking in Zimbabwe????????
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CASE PRESENTATION Mrs. Sibanda was admitted to Harare Central Hospital on the 23rd of Nov 2016 due to fever, abdominal pain, shortness of breath and generalized body weakness.
Patient history was obtained from her adult son: Age: 57 Nationality: Zimbabwean Occupation: Farmer HISTORY OF PRESENT ILLNESS: Two weeks prior to admission patient was noted to be jaundiced but just ignored it. Then four days prior to admission, while patient was working in her field, she suddenly experienced body weakness and the next day she had fever and did not go back to the field from then on. She was given a medication (paracetamol) as an analgesic and for relieving fever, by her son. Until eight hours prior to admission patient defecated a black colored stool and experienced shortness of breath and seemed confused. She was then rushed to the hospital with abnormal vital signs: BP: 150/100 mmHg and Temp: 38.5oC
HISTORY OF PAST ILLNESS: Patient was diagnosed with Diabetes Mellitus type 2 at the age of 46. She has maintained medication of Metformin. She is also hypertensive.
During assessment, Mrs Sibanda stated that she has been working as a famer at Maxwell farm in Mazowe for more than 15 years. Patient also stated that she was a heavy alcoholic drinker up to the point she was diagnosed with DM.
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TYPES OF HEPATIC ENCEPHALOPATHY (HE)
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PRECIPITATING FACTORS
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PATHOGENESIS Ammonia formed by protein breakdown (bacterial) in GIT
Liver Liver dysfunction (abnormal) NH3
Passes BBB Hepatic encephalopathy Brain
Other factors: Increased circulating levels of drugs e.g. benzodiazepines.
Increased sensitivity to glutamine & GABA (inhibitory neurotransmitter)
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CLINICAL FEATURES B. Changes in personality
• Childish behavior• Euphoria• May be aggressive
C. Neurological signs• Flapping tremor (Asterixis)• Exaggerated tendon reflex• Jumbled & slurred speech• Slow movement
A. Disturbances in consciousness• Mental confusion • Poor concentration• Drowsiness• Disturbance in sleep pattern• Impaired memory• Coma
•(Fever)
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DIAGNOSIS Diagnosis is usually made clinically on the basis of patient history and clinical examination Routine Investigations include:• LFTs• Urea, Electrolytes and Creatinine• FBC• PT (INR)• Albumin/Globulin ratio (A/G ratio)• Blood ammonia concentration Electroencephalogram (EEG) CSF & CT scan
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TREATMENT AIMS AT: Reducing production and absorption of gut derived ammonia and other toxins Identification and treatment of precipitating factors Correcting any electrolytes imbalance Liver transplant
05/01/2023
CASE PRESENTATION Mrs. Sibanda was admitted to Harare Central Hospital on the 23rd of Nov 2016 due to fever, abdominal pain, shortness of breath and generalized body weakness.
Patient history was obtained from her adult son: Age: 57 Nationality: Zimbabwean Occupation: Farmer HISTORY OF PRESENT ILLNESS: Two weeks prior to admission patient was noted to be jaundiced but just ignored it. Then four days prior to admission, while patient was working in her field, she suddenly experienced body weakness and the next day she had fever and did not go back to the field from then on. She was given a medication (paracetamol) as an analgesic and for relieving fever, by her son. Until eight hours prior to admission patient defecated a black colored stool and experienced shortness of breath and seemed confused. She was then rushed to the hospital with abnormal vital signs: BP: 150/100 mmHg and Temp: 38.5oC
HISTORY OF PAST ILLNESS: Patient was diagnosed with Diabetes Mellitus type 2 at the age of 46. She has maintained medication of Metformin. She is also hypertensive.
During assessment, Patient X stated that she has been working as a famer at Maxwell farm in Mazowe for more than 15 years. Patient also stated that she was a heavy alcohol drinker up to the point she was diagnosed with DM.
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QUESTIONS From the Clinical presentation and medical history of the patient:What is the probable diagnosis? What are the causes of her illness? Was it wise for the son to administer paracetamol to the mother and why? What are the management and treatment options for Mrs. Sibanda?
FOUR CORNERS
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