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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

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

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