ENCEPHALOPATHY

ENCEPHALOPATHY
DISORDER OF CEREBRAL
FUNCTION ==> Inflammation (-)
DIGESTIVE TRACT
1. Hepatic Encephalopathy
2. Kernicterus
3. Reye Syndrome
4. Dehydration +disorder of consciousness
5. Hypo/hypernatremia
severe hypophosphatemia
GE + SEVERE DEHYDRATION
CIRCULATORY DISTURBANCES
OXYGENATION
CONSCIOUSNESS
GE+SEVERE DEHYDRATION+ENCEPHALOPATHY
COMA SHOCK
P
< 1 mg %
Energy
Dysfunction of
leucocytes &
thrombocytes
RBC
Rhabdomyolisis
O
2
delivery



Cerebral Anoxia
KERNICTERUS
= BILIRUBIN ENCEPHALOPATHY
Unconsciousness
Spasme
Convulsion
Mortality 75%
Recovery - Blind
- Deafness
- Neuromusc. Incoord.
(chorea athetosis)
1. EXCHANGE TRANSFUSION ==> UNCONJUG.
BILIRUBIN > 20 mg %
Th
2. PHOTOTHERAPY
3. PHENOBARBITAL
4. INHIBITION OF ABSORPTION
5. TIN PROTOPORFIRIN
INHIBITION OF BILIVERDIN TO BILIRUBIN
6. 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 ENCEPHALOPATHY
I. CONFUSED
II. DROWSY
III. STUPOROUS
IV. - COMA

- DEEP COMA
HEPATIC COMA
portal v.
Inferior v. cava
Systemic
liver
Porto systemic encephelopathy
LIVER FAILURE
ENCEPHALOPATHY
COAGULOPATHY
DYSFUNCTION
INTRAHEPATIC
METABOLISM
HALLMARK
1. VENTILATION
2. WATER & ELECTROLYTES
3. COAGULOPATHY:
- Vitamin K
- Transfusion : Fresh Frozen Plasma
4. BLOOD AMMONIA (NH
3
) :
- lactulose
- neomycine Nephrotoxic
5. REDUCING INTRACRANIAL PRESSURE :
- cerebral edem : steroid, mannitol, etc.
- hypokarbia Cerebral Blood Flow
6. MONITORED CLOSELY FOR INFECTION
7. HEPATOTOXIC DRUGS WITHDRAWN :
- eg : Sedative
THERAPY :
BLOOD NH
3
ENCEPHALOPATHY
FATTY DEGENERATION
HYPOGLYCEMIA
Mitochondrial dysfunction
ACUTE
SALICYLIC ACID
REYE SYNDROME
1. CONTROL OF INTRACRANIAL PRESSURE
Th
2. WATER & ELECTROLYTES
3. ADEQUATE OXYGENATION
4. CONTROL OF HYPOGLICEMIA
5. COAGULOPATHY IS MANAGED
6. EXCHANGE TRANSFUSION