Grades and Clinical Manifestations of Hepatic Encephalopathy

Derajat dan Manifestasi Ensefalopati Hepatik

Hepatic Encephalopathy (HE) is characterized by neuropsychiatric abnormalities that are primarily caused by nitrogenous products, endogenous ligands for benzodiazepines, and other unknown toxins released by bacteria from the colon that are incompletely metabolized by the cirrhotic liver or bypass the liver because of portal hypertension and portosystemic shunting. HE can develop in 28% of cirrhotic patients within 10 years of the diagnosis of cirrhosis and portal hypertension. Older age and severity of cirrhosis are the only known factors to predict the risk of developing HE. HE has five stages for its severity: Stage 0 is normal or only features abnormal results on psychometric tests, referred to as minimal HE, and stage 4 represents the most severe form with deep coma.

Encephalopathy Grade	Level of Consciousness	Mental Status	Neurologic Signs	EEG Abnormalities
0	Normal	Normal	None	None
Subclinical	Normal	Normal	Psychometric tests may be abnormal	None
1	Day-night reversal, restlessness	Forgetful, mild confusion, Irritable	Tremor, apraxia, impaired handwriting	Triphasic waves (5 cycles/s)
2	Lethargy	Disorientation to time, inappropriate behavior	Asterixis, ataxia, dysarthria	Triphasic waves (5 cycles/s)
3	Somnolent, confused	Disorientation to time, inappropriate behavior	Asterixis, hyperreflexia, Babinski signs	Triphasic waves (5 cycles/s)
4	Coma	None	Decerebration	Delta activity

Referensi:
Conn's Current Therapy 60th Edition (Saunders) 2008

Tags: Lecture Notes