Hepatic encephalopathy history and symptoms: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hepatic encephalopathy}} | {{Hepatic encephalopathy}} | ||
{{CMG}} | {{CMG}};{{AE}}{{MMJ}} | ||
==Overview== | ==Overview== | ||
In patients with hepatic encephalopathy, [[symptoms]] may have an insidious onset and progression, or may begin suddenly and progress rapidly. The [[hallmark]] of hepatic encephalopathy is [[hyperammonemia]]. A positive history of [[hepatic failure]] is suggestive of hepatic encephalopathy. The most common [[symptoms]] of hepatic encephalopathy include inverted [[Sleep-wake schedule|sleep-wake pattern]] (combination of restless nights and [[excessive daytime sleepiness]]), [[personality changes]], [[Altered mental status|altered level of consciousness]], bilateral flapping hand [[tremors]] on [[arm]] [[extension]] ([[asterixis]]), [[confusion]] and [[irritability]]. | |||
==History and Symptoms== | ==History and Symptoms== | ||
In patients with hepatic encephalopathy, [[symptoms]] may have an insidious onset and progression, or may begin suddenly and progress rapidly. The [[hallmark]] of hepatic encephalopathy is [[hyperammonemia]] leading to [[altered mental status]].<ref name="pmid17372808">{{cite journal| author=Rimar D, Kruzel-Davila E, Dori G, Baron E, Bitterman H| title=Hyperammonemic coma--barking up the wrong tree. | journal=J Gen Intern Med | year= 2007 | volume= 22 | issue= 4 | pages= 549-52 | pmid=17372808 | doi=10.1007/s11606-007-0131-6 | pmc=1829435 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17372808 }} </ref> A positive history of [[hepatic failure]] is suggestive of hepatic encephalopathy. The most common [[symptoms]] of hepatic encephalopathy include inverted [[Sleep-wake schedule|sleep-wake pattern]] (combination of restless nights and [[excessive daytime sleepiness]])<ref name="pmid26041958">{{cite journal| author=Montagnese S, Turco M, Amodio P| title=Hepatic encephalopathy and sleepiness: an interesting connection? | journal=J Clin Exp Hepatol | year= 2015 | volume= 5 | issue= Suppl 1 | pages= S49-53 | pmid=26041958 | doi=10.1016/j.jceh.2014.06.006 | pmc=4442851 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26041958 }} </ref>, [[personality changes]]<ref name="pmid28533911">{{cite journal| author=Ferenci P| title=Hepatic encephalopathy. | journal=Gastroenterol Rep (Oxf) | year= 2017 | volume= 5 | issue= 2 | pages= 138-147 | pmid=28533911 | doi=10.1093/gastro/gox013 | pmc=5421503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28533911 }} </ref>, altered level of [[consciousness]]<ref name="pmid4340155">{{cite journal| author=al-Arif A, Sporn MB| title=2'-O-methylation of adenosine, guanosine, uridine, and cytidine in RNA of isolated rat liver nuclei. | journal=Proc Natl Acad Sci U S A | year= 1972 | volume= 69 | issue= 7 | pages= 1716-9 | pmid=4340155 | doi= | pmc=426785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4340155 }} </ref>, bilateral flapping hand [[tremors]] on [[arm]] [[extension]] ([[asterixis]])<ref name="pmid27089111">{{cite journal| author=Agarwal R, Baid R| title=Asterixis. | journal=J Postgrad Med | year= 2016 | volume= 62 | issue= 2 | pages= 115-7 | pmid=27089111 | doi=10.4103/0022-3859.180572 | pmc=4944342 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27089111 }} </ref>, [[confusion]] and [[irritability]].<ref name="pmid23006457">{{cite journal| author=Bleibel W, Al-Osaimi AM| title=Hepatic encephalopathy. | journal=Saudi J Gastroenterol | year= 2012 | volume= 18 | issue= 5 | pages= 301-9 | pmid=23006457 | doi=10.4103/1319-3767.101123 | pmc=3500018 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23006457 }} </ref> | |||
===History=== | |||
Patients with hepatic encephalopathy may have a positive history of:<ref name="pmid28680841">{{cite journal| author=Djiambou-Nganjeu H| title=Hepatic Encephalopathy in Liver Cirrhosis. | journal=J Transl Int Med | year= 2017 | volume= 5 | issue= 1 | pages= 64-67 | pmid=28680841 | doi=10.1515/jtim-2017-0013 | pmc=5490964 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28680841 }} </ref><ref name="pmid26041950">{{cite journal| author=Acharya SK| title=Management in acute liver failure. | journal=J Clin Exp Hepatol | year= 2015 | volume= 5 | issue= Suppl 1 | pages= S104-15 | pmid=26041950 | doi=10.1016/j.jceh.2014.11.005 | pmc=4442864 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26041950 }} </ref><ref name="pmid28533911">{{cite journal| author=Ferenci P| title=Hepatic encephalopathy. | journal=Gastroenterol Rep (Oxf) | year= 2017 | volume= 5 | issue= 2 | pages= 138-147 | pmid=28533911 | doi=10.1093/gastro/gox013 | pmc=5421503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28533911 }} </ref><ref name="pmid23006457">{{cite journal| author=Bleibel W, Al-Osaimi AM| title=Hepatic encephalopathy. | journal=Saudi J Gastroenterol | year= 2012 | volume= 18 | issue= 5 | pages= 301-9 | pmid=23006457 | doi=10.4103/1319-3767.101123 | pmc=3500018 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23006457 }} </ref><ref name="pmid27457247">{{cite journal| author=Jepsen P, Christensen J, Weissenborn K, Watson H, Vilstrup H| title=Epilepsy as a risk factor for hepatic encephalopathy in patients with cirrhosis: a cohort study. | journal=BMC Gastroenterol | year= 2016 | volume= 16 | issue= 1 | pages= 77 | pmid=27457247 | doi=10.1186/s12876-016-0487-3 | pmc=4960784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27457247 }} </ref><ref name="pmid20602681">{{cite journal| author=Guevara M, Baccaro ME, Ríos J, Martín-Llahí M, Uriz J, Ruiz del Arbol L et al.| title=Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: relevance of serum sodium concentration. | journal=Liver Int | year= 2010 | volume= 30 | issue= 8 | pages= 1137-42 | pmid=20602681 | doi=10.1111/j.1478-3231.2010.02293.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20602681 }} </ref><ref name="pmid26206073">{{cite journal| author=Jepsen P, Watson H, Andersen PK, Vilstrup H| title=Diabetes as a risk factor for hepatic encephalopathy in cirrhosis patients. | journal=J Hepatol | year= 2015 | volume= 63 | issue= 5 | pages= 1133-8 | pmid=26206073 | doi=10.1016/j.jhep.2015.07.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26206073 }} </ref> | |||
* | *[[Cirrhosis|Hepatic cirrhosis]] | ||
*[[ | *[[Hepatic failure]] | ||
*[[ | *[[Gastrointestinal bleeding]] | ||
*[[Portacaval shunt]] | |||
*[[Epilepsy]] | |||
*[[Diabetes mellitus]] | |||
*[[Hyponatremia|Hyponatraemia]] | |||
*[[Renal failure]] | |||
*[[Bilirubinemia|Hyperblilirubinemia]] | |||
*[[Hypokalemia]] | |||
*[[Sepsis]] | |||
===Common symptoms=== | |||
Common [[symptoms]] of hepatic encephalopathy include: | |||
*[[Personality changes]] | |||
*Altered level of [[consciousness]] | |||
*[[Bilateral]] flapping hand [[tremors]] on [[arm]] [[extension]] ([[asterixis]]) | |||
*[[Confusion]] | |||
*I[[irritability|rritability]] | |||
*Inverted [[Sleep-wake schedule|sleep-wake pattern]] (combination of restless nights and excessive [[daytime sleepiness]]) | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
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[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 15:36, 26 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
In patients with hepatic encephalopathy, symptoms may have an insidious onset and progression, or may begin suddenly and progress rapidly. The hallmark of hepatic encephalopathy is hyperammonemia. A positive history of hepatic failure is suggestive of hepatic encephalopathy. The most common symptoms of hepatic encephalopathy include inverted sleep-wake pattern (combination of restless nights and excessive daytime sleepiness), personality changes, altered level of consciousness, bilateral flapping hand tremors on arm extension (asterixis), confusion and irritability.
History and Symptoms
In patients with hepatic encephalopathy, symptoms may have an insidious onset and progression, or may begin suddenly and progress rapidly. The hallmark of hepatic encephalopathy is hyperammonemia leading to altered mental status.[1] A positive history of hepatic failure is suggestive of hepatic encephalopathy. The most common symptoms of hepatic encephalopathy include inverted sleep-wake pattern (combination of restless nights and excessive daytime sleepiness)[2], personality changes[3], altered level of consciousness[4], bilateral flapping hand tremors on arm extension (asterixis)[5], confusion and irritability.[6]
History
Patients with hepatic encephalopathy may have a positive history of:[7][8][3][6][9][10][11]
Common symptoms
Common symptoms of hepatic encephalopathy include:
- Personality changes
- Altered level of consciousness
- Bilateral flapping hand tremors on arm extension (asterixis)
- Confusion
- Irritability
- Inverted sleep-wake pattern (combination of restless nights and excessive daytime sleepiness)
References
- ↑ Rimar D, Kruzel-Davila E, Dori G, Baron E, Bitterman H (2007). "Hyperammonemic coma--barking up the wrong tree". J Gen Intern Med. 22 (4): 549–52. doi:10.1007/s11606-007-0131-6. PMC 1829435. PMID 17372808.
- ↑ Montagnese S, Turco M, Amodio P (2015). "Hepatic encephalopathy and sleepiness: an interesting connection?". J Clin Exp Hepatol. 5 (Suppl 1): S49–53. doi:10.1016/j.jceh.2014.06.006. PMC 4442851. PMID 26041958.
- ↑ 3.0 3.1 Ferenci P (2017). "Hepatic encephalopathy". Gastroenterol Rep (Oxf). 5 (2): 138–147. doi:10.1093/gastro/gox013. PMC 5421503. PMID 28533911.
- ↑ al-Arif A, Sporn MB (1972). "2'-O-methylation of adenosine, guanosine, uridine, and cytidine in RNA of isolated rat liver nuclei". Proc Natl Acad Sci U S A. 69 (7): 1716–9. PMC 426785. PMID 4340155.
- ↑ Agarwal R, Baid R (2016). "Asterixis". J Postgrad Med. 62 (2): 115–7. doi:10.4103/0022-3859.180572. PMC 4944342. PMID 27089111.
- ↑ 6.0 6.1 Bleibel W, Al-Osaimi AM (2012). "Hepatic encephalopathy". Saudi J Gastroenterol. 18 (5): 301–9. doi:10.4103/1319-3767.101123. PMC 3500018. PMID 23006457.
- ↑ Djiambou-Nganjeu H (2017). "Hepatic Encephalopathy in Liver Cirrhosis". J Transl Int Med. 5 (1): 64–67. doi:10.1515/jtim-2017-0013. PMC 5490964. PMID 28680841.
- ↑ Acharya SK (2015). "Management in acute liver failure". J Clin Exp Hepatol. 5 (Suppl 1): S104–15. doi:10.1016/j.jceh.2014.11.005. PMC 4442864. PMID 26041950.
- ↑ Jepsen P, Christensen J, Weissenborn K, Watson H, Vilstrup H (2016). "Epilepsy as a risk factor for hepatic encephalopathy in patients with cirrhosis: a cohort study". BMC Gastroenterol. 16 (1): 77. doi:10.1186/s12876-016-0487-3. PMC 4960784. PMID 27457247.
- ↑ Guevara M, Baccaro ME, Ríos J, Martín-Llahí M, Uriz J, Ruiz del Arbol L; et al. (2010). "Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: relevance of serum sodium concentration". Liver Int. 30 (8): 1137–42. doi:10.1111/j.1478-3231.2010.02293.x. PMID 20602681.
- ↑ Jepsen P, Watson H, Andersen PK, Vilstrup H (2015). "Diabetes as a risk factor for hepatic encephalopathy in cirrhosis patients". J Hepatol. 63 (5): 1133–8. doi:10.1016/j.jhep.2015.07.007. PMID 26206073.