Hepatic Encephalopathy

- is a nervous system disorder brought on by severe liver disease.

Predisposing Factors Precipitating Factors

Genetics Exposure to Hep B Virus

Hepatitis B Virus enters the circulation HBsAg - reactive

Release of cytokines by immune cells Fever

RUQ Pain Liver inflammation High Neutrophils: 0.88

Low lymphocytes: 0.02
Hepatocytes are invaded and
damaged

Impaired bilirubin clearance Deterioration in liver function

Icteric Jaundice Liver Cirrhosis

Sclera

Impaired detoxification of liver Increases vascular resistance

Increased ammonia levels Portal hypertension

Vasodilators released from

Ammonia travels to the brain
portal vein endothelium
bypassing the Blood Brain Barrier

Shunting of flow to Systemic hypotension

Brain edema splanchnic circulation

Decreased renal Cool skin

HEPATIC ENCEPHALOPATHY
perfusion
Pale palpebral
Altered Level of Consciousness conjunctiva
Increased creatinine level:
2095 umol/L
Weak
Coma, unresponsiveness Increased BUA: 684 umol/L pulses

Decreased BP
GCS score: 4
BP: 80/40mmHg
(E1,V2,M1) Low hemoglobin:
60g/L Low Sodium
Low hematocrit: value of
0.17L/L 123.6mmol/L