A Clinical Analysis Of 74 Cases Of Type C Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a major complication of acute and chronic liver failure, defined as a disturbance in central nervous system function because of hepatic insufficiency. It is characterized by personality changes, intellectual impairment, and a depressed level of consciousness. The most commom type of HE is the encephalopathy associated with cirrhosis and portal hypertension and/or portal-systemic shunts, alternative term: type C encephalopathy. Subtle signs of hepatic encephalopathy are observed in nearly 70% of patients with cirrhosis. Approximately 20-30% of patients die of end-stage liver disease experience significant encephalopathy, approaching coma. Therefore, HE continues to be a major clinical problem of hepatology. Objective and methods: To study the clinical features and prognosis of patients with type C encephalopathy.74 cases with hepatic encephalopathy of cirrhosis between 1999. 1 and 2004.1, diagnosed by clinical, biochemical, histological and psychometric methods, were selected.Other metabolic disorders, infectious diseases, intracranial vascular events, and intracranial spaceoccupying lesions must be exclusived. The clinical stages of hepatic encephalopathy are as follows: Stage 1. Trivial lack of awareness. Shortened attention span. Impaired addition or subtraction. Hypersomnia, insomnia, or inversion of sleep pattern. Euphoria or depression. Asterixis can be detected. Stage 2. Lethargy or apathy. Disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis. Stage 3. Gross disorientation. Bizarre behavior. Semistupor to stupor. Asterixis generally absent. Stage 4. Coma. Results: Seventy-four patients with histologically proven cirrhosis (54 male, 20female; mean age 53.9 years; SD11.1; range 27.5-77.9 years) were entred the analysis. The etiology of cirrhosis was chronic viral hepatitis in 66 patients, alcohol abuse in 6 patients. The overall hospital mortality was 22.97%. The factors that can precipitate hepatic encephalopathy of cirrhosis are well recognized, and include gastrointestinal bleeding (44.6%), infection (39.2%), electrolyte disturbances (35.1%), medications (21.6%), renal failure (18.9%), dietary protein overload (13.6%), constipation (10.8%), diarrhea (5.4%), and others (5.4%). The major causes of death were gastrointestinal bleeding, renal failure and infection. The patients with more precipitating factors had worse outcomes. jaundice, ascites and abnormal sleep were found in more than 50% of patients with HE. There were significant differences in the investigations between the survival and the dead. According to the Child classification, the patients with degree C had the most serious sympotom, the most complications and the worst prognosis. Conclusions: The peak ages of hepatid encephalopathy of cirrhosis was 40-70 years old. The major etiology of cirrhosis was chronic viral hepatitis. The overall hospital mortality was 22.97%. Gastrointestinal bleeding, infection, and electrolyte disturbances were the three most commom precipitating factors in patients with type C encephalopathy. The patients with more precipitating factors had worse outcomes. The Child classification can help predict the prognosis. Prevention and removal of precipitating factors and complications are the key managements.