Hepatic encephalopathy natural history, complications and prognosis: Difference between revisions
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=== Natural History === | === Natural History === | ||
Hepatic encephalopathy may occur as an [[acute]], potentially reversible disorder or it may occur as a [[Chronic (medical)|chronic]], progressive disorder that is associated with [[chronic liver disease]]. | Hepatic encephalopathy may occur as an [[acute]], potentially reversible disorder or it may occur as a [[Chronic (medical)|chronic]], progressive disorder that is associated with [[chronic liver disease]].<ref name="pmid21278704">{{cite journal| author=Toris GT, Bikis CN, Tsourouflis GS, Theocharis SE| title=Hepatic encephalopathy: an updated approach from pathogenesis to treatment. | journal=Med Sci Monit | year= 2011 | volume= 17 | issue= 2 | pages= RA53-63 | pmid=21278704 | doi= | pmc=3524698 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21278704 }} </ref> | ||
* If left untreated, patients with hepatic encephalopathy may progress to develop [[brain edema]], secondary structural damage to the brain, and death.<ref name="pmid24665321">{{cite journal| author=Dara N, Sayyari AA, Imanzadeh F| title=Hepatic encephalopathy: early diagnosis in pediatric patients with cirrhosis. | journal=Iran J Child Neurol | year= 2014 | volume= 8 | issue= 1 | pages= 1-11 | pmid=24665321 | doi= | pmc=3943054 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24665321 }} </ref> | * If left untreated, patients with hepatic encephalopathy may progress to develop [[brain edema]], secondary structural damage to the brain, and death.<ref name="pmid24665321">{{cite journal| author=Dara N, Sayyari AA, Imanzadeh F| title=Hepatic encephalopathy: early diagnosis in pediatric patients with cirrhosis. | journal=Iran J Child Neurol | year= 2014 | volume= 8 | issue= 1 | pages= 1-11 | pmid=24665321 | doi= | pmc=3943054 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24665321 }} </ref> | ||
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Overview
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Natural History, Complications, and Prognosis
Natural History
Hepatic encephalopathy may occur as an acute, potentially reversible disorder or it may occur as a chronic, progressive disorder that is associated with chronic liver disease.[1]
- If left untreated, patients with hepatic encephalopathy may progress to develop brain edema, secondary structural damage to the brain, and death.[2]
Complications
- Common complications of hepatic encephalopathy include:[3][4]
- Status epilepticus
- Aspiration(due to overuse of lactulose)
- Hypernatremia(due to overuse of lactulose)
- Severe perianal skin irritation(due to overuse of lactulose)
- death
Prognosis
- Prognosis of patients with hepatic encephalopathy is generally poor:
- One year survival rate of patients with hepatic encephalopathy is approximately 42%.
- Three year survival rate of patients with hepatic encephalopathy is approximately 23%.
- The presence of some factors is associated with a particularly poor prognosis among patients with hepatic encephalopathy.
- male sex
- Increased serum bilirubin
- Increased alkaline phosphatase
- Increased potassium and blood urea nitrogen
- Decreased serum albumin
- Decreased prothrombin activity
Overview
Hepatic encephalopathy leads to changed cognitive function. This can range from subtle deficits in higher mental functions (in mild cases) to obtundation and coma (in severe cases). Left untreated, severe hepatic encephalopathy can cause death.
Natural History
Hepatic encephalopathy may occur as an acute, potentially reversible disorder or it may occur as a chronic, progressive disorder that is associated with chronic liver disease.
Complications
- Brain herniation
- Brain swelling
- Increased risk of:
- Permanent nervous system damage to movement, sensation, or mental state
- Progressive, irreversible coma
- Side effects of medications
Prognosis
Acute hepatic encephalopathy may be treatable. Chronic forms of the disorder often keep getting worse or continue to come back. Both forms may result in irreversible coma and death. Approximately 80% (8 out of 10 patients) die if they go into a coma. Recovery and the risk of the condition returning vary from patient to patient.
References
- ↑ Toris GT, Bikis CN, Tsourouflis GS, Theocharis SE (2011). "Hepatic encephalopathy: an updated approach from pathogenesis to treatment". Med Sci Monit. 17 (2): RA53–63. PMC 3524698. PMID 21278704.
- ↑ Dara N, Sayyari AA, Imanzadeh F (2014). "Hepatic encephalopathy: early diagnosis in pediatric patients with cirrhosis". Iran J Child Neurol. 8 (1): 1–11. PMC 3943054. PMID 24665321.
- ↑ Eleftheriadis N, Fourla E, Eleftheriadis D, Karlovasitou A (2003). "Status epilepticus as a manifestation of hepatic encephalopathy". Acta Neurol Scand. 107 (2): 142–4. PMID 12580865.
- ↑ Ferenci P (2017). "Hepatic encephalopathy". Gastroenterol Rep (Oxf). 5 (2): 138–147. doi:10.1093/gastro/gox013. PMC 5421503. PMID 28533911.