Ahuja, Kanya Lal

jaipal,

Khowaja, Ameer A.

Mahmood, Khalid

Rohra, Dileep K.

English

eCommons@AKU

eCommons@AKUDepartment of Medicine Department of MedicineFebruary 2008Precipitating factors and the outcome of hepaticencephalopathy in liver cirrhosis.Dileep K. RohraAga Khan University, dileep.rohra@aku.edujaipalAga Khan UniversityAmeer A. KhowajaAga Khan UniversityKhalid MahmoodAga Khan UniversityKanya Lal AhujaAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_med_medPart of the Gastroenterology CommonsRecommended CitationRohra, D. K., jaipal, ., Khowaja, A. A., Mahmood, K., Ahuja, K. L. (2008). Precipitating factors and the outcome of hepaticencephalopathy in liver cirrhosis.. JCPSP: Journal of the College of Physicians and Surgeons--Pakistan., 18(2), 130-131.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_med_med/222130 Journal of The College of Physicians and Surgeons Pakistan  2008, Vol. 18 (2): 130-131Patients with chronic liver disease (CLD) constitute asignificant burden on the economy of the country.Approximately 3% of global population is estimated tobe chronically infected with hepatitis C virus with anannual incidence of 3 to 4 million new cases globally.1Patients with CLD frequently experience episodes ofexacerbations including hepatic encephalopathyprecipitated by variety of established precipitants.2Hepatic encephalopathy is defined as a spectrum ofneuropsychiatric abnormalities in patients with liverdysfunction, after exclusion of other known braindisease.2 It is characterized by personality changes,intellectual impairment, and a depressed level ofconsciousness. Identification of the precipitants and theirprevention and/or immediate seeking of tertiary carefacility may have significant impact on morbidityand mortality of patients presenting with hepaticencephalopathy. The objective of this study was todetermine the frequency of factors likely to precipitate thehepatic encephalopathy in patients with CLD presentingto the Medical Wards of Civil Hospital, Karachi.Patients admitted to Medical Wards at Civil Hospital,Karachi, from August 1, 2006 to December 31, 2006were selected. Inclusion criteria included those patientswho already had the established diagnosis of CLD onthe basis of history, physical examination, laboratory,and radiological tests. The diagnosis of the hepaticencephalopathy and the likely precipitating factor wasmade by the Incharge of the ward. Once, the patientsbecame stabilized, they were also interviewed in orderto know more about the precipitating factor.Two hundred fifty-six patients with CLD were recruited inthis study to determine the most likely precipitatingfactor of hepatic encephalopathy. The results aresummarized in Table I. Infections including spontaneousbacterial peritonitis were noted to be the major incitingstimuli for precipitating hepatic encephalopathy. Amongthe drug-precipitated hepatic encephalopathy patients,frusemide and propranolol were identified as the likelyculprits.Hepatic encephalopathy is a complicated disorder,the pathophysiology of which remains to be fullyunderstood. Current common theories explaininghepatic encephalopathy include the potentialinvolvement of ammonia, gamma-aminobutyric acid/benzodiazipines and false neurotransmitters.3 On mostoccasions, hepatic encephalopathy appears due to asuperimposed precipitating factor (gastrointestinalbleeding, infections, renal and electrolyte disturbances,etc.).4 In addition to other things, elimination ortreatment of the precipitating factors remains animportant therapeutic goal. Earliest possible diagnosisand timely intervention is at the core of managementand prevention of progression of CLD. Awareness aboutthe nature and frequency of precipitating factors to notonly health care professionals but also to patientpopulation with their subsequent avoidance cancontribute significantly in preventing the diseaseprogression and episodes of exacerbation. Sincespecific precipitating factors have specific treatment,prompt identification of particular precipitating factor is amust to prolong the life expectancy and to improve thequality of life of patients with hepatic encephalopathy.5This may provide some mortality benefit and may alsoimprove      the quality of lives of patients suffering fromCLD. This study, is the first of its kind in Pakistan to show thefrequency of the precipitating factors of hepaticencephalopathy in patients with CLD. This may helpphysician in setting their priorities while managingpatients with hepatic encephalopathy.REFERENCES1. World Health Organization. Hepatitis C. Fact sheet No. 164.[online] 2000 [cited 2006 Feb 2]. Available from:h t t p : / /www.who . i n t /med iacen t re / f ac t shee t s / f s164 /Precipitating Factors of HepaticEncephalopathy in Patients withChronic Liver Disease at CivilHospital Karachi Dileep K. Rohra1, Jaipal2, Ameer A. Khowaja1, KhalidMahmood2 and Kanya Lal Ahuja1SHORT COMMUNICATION1 Department of Biological and Biomedical Sciences,Aga Khan University Hospital, Karachi.2 Department of Medicine, Civil Hospital, Karachi.Correspondence: Dr. Dileep K. Rohra,D-701, Zainab Plaza, Gulshan-e-Iqbal, Block-17, Karachi. E-mail: dileep.rohra@aku.eduReceived July 19, 2007; accepted  December 12, 2007.Table I: Most likely participating factor for hepatic encephalopathy. Most likely precipitating factor Frequency %Gastrointestinal bleeding 39 15.2Constipation 31 12.1Spontaneous Bacterial  Peritonitis (SBP) 28 10.9Infections other than SBP 23 9.0Drugs 4 1.6Other 1 0.4Not known 130 50.8Total 256 100.0en/print.htm. 2. Riordan SM, Williams R. Treatment of hepatic encephalopathy.N Engl J Med 1997;  337:473-9.3. Faint V. The pathophysiology of hepatic encephalopathy. NursCrit Care 2006; 11: 69-74. 4. Mas A. Hepatic encephalopathy: from pathophysiology totreatment. Digestion 2006; 73 (suppl 1):86-93.5. Gerber T, Shomerus H. Hepatic encephalopathy in livercirrhosis: pathogenesis, diagnosis and management. Drugs2000; 60:1353-70.Journal of The College of Physicians and Surgeons Pakistan  2008, Vol. 18 (2): 130-131 131Precipitating factors of hepatic encephalopathy in patients with chronic liver disease         

Precipitating factors and the outcome of hepatic encephalopathy in liver cirrhosis.

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Precipitating factors and the outcome of hepatic encephalopathy in liver cirrhosis.

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