Harshal KHOBRAGADE, Tanuja MANOHAR, Amol SATHAWANE

Hepatik Ensefalopati Tip C Hastalarında Tetikleyici Faktörler ve Kliniko-Endoskopik Çalışma

Giriş: Hepatik ensefalopati (HE), ağır karaciğer hastalığı ve vücuttan toksinleri atmakta yetersiz kalması sonucu beyin fonksiyonlarında azalmadır. Kişilik değişiklikleri, zihinsel bozulma ve bilinç kaybı ile karakterizedir. Bu çalışma, karaciğer sirozu olan hastalarda hepatik ensefalopatinin tetikleyici faktörlerini ve endoskopik özelliklerini belirlemek ve Orta Hindistan'da üçüncü basamak bir hastaneye kabul edilen ilişkili klinik özellikleri değerlendirmek için yapılmıştır. Gereç ve Yöntem: Bu hastane bazlı tanımlayıcı kesitsel çalışma, Kasım 2016 ile Ekim 2018 tarihleri arasında, 18 yaş üstü hepatik ensefalopati tip C'li 102 hasta üzerinde yürütülmüştür. tasarlanmış proforma Kategorik sonuçların çalışma grupları arasında Ki kare testi/Fisher's Exact testi kullanılarak karşılaştırıldığı istatistiksel analiz için gönderildiler. Bulgular: Çalışmamızda HE prevalansı %19,6 idi. Bu çalışmada HE için önde gelen presipitanlar arasında kabızlık (%26,5), elektrolit dengesizliği (%21,6), böbrek yetmezliği (%18,6) ve üst gastrointestinal kanama (%18,6) olduğunu gözlemledik. Karaciğer yetmezliğinin yanı sıra, pıhtılaşma anormallikleri, böbrek düzensizliği ve serum sodyum seviyelerindeki değişiklikler gibi çeşitli faktörlerdeki ilişkili anormallikler, HE'nin daha yüksek derecelere ilerlemesine neden olabilir. Sonuç: Siroz seyrinde kabızlık, elektrolit dengesizliği, böbrek yetmezliği ve üst GİS kanaması gibi farklı faktörlerin HE gelişimini önlemeye yardımcı olması için erken dönemde belirlenmesi önemlidir.

Anahtar Kelimeler:

Beyin, siroz, hepatik ensefalopati, karaciğer, kolaylaştıran faktörler

Precipitating Factors and Clinico-Endoscopic Study of Patients with Hepatic Encephalopathy Type C

Introduction: Hepatic encephalopathy (HE) is a decline in brain function as a result of severe liver disease and its inadequacy to remove toxins from the body. It is characterized by personality changes, intellectual impairment, and loss of consciousness. This study was conducted to determine the precipitating factors and endoscopic features of hepatic encephalopathy in patients with liver cirrhosis and evaluate the associated clinical features admitted in a tertiary hospital in Central India. Materials and Methods: This hospital-based descriptive cross-sectional study was conducted from November 2016 to October 2018 on 102 patients with hepatic encephalopathy type C, aged above 18. All patients were carefully examined, relevant investigations performed, and data collected through pre-designed proforma. They were sent for statistical analysis where categorical outcomes were compared between study groups using the Chi-square test /Fisher's Exact test. Results: The prevalence of HE was 19.6% in our study. In this study, we observed that constipation (26.5%), electrolyte imbalance (21.6%), renal failure (18.6%), and upper GI bleeding (18.6%) be among the leading precipitants for HE. Besides liver failure, the associated abnormalities in various factors like coagulation abnormalities, renal derangement, and changes in serum sodium levels can lead to the progression of HE to higher grades. Conclusion: It is essential to identify the different factors like constipation, electrolyte imbalance, renal failure, and upper GI bleeding early in the course of cirrhosis to help prevent the development of HE.

Keywords:

Brain, Cirrhosis, Hepatic Encephalopathy, Liver, Precipitating Factors,

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1. Shawcross DL, Dunk AA, Jalan R, et al. How to diagnose and manage hepatic encephalopathy: a consensus statement on roles and responsibilities beyond the liver specialist. Eur J Gastroenterol Hepatol. 2016;28(2):146–52.
2. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715–35.
3. Poordad FF. Review article: The burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25(SUPPL. 1):3–9.
4. Ferri F. Ferri’s clinical advisor 2018. 1 ed. Rhode Island: Elsevier; 2017. 2064 p.
5. Wijdicks EF. Hepatic encephalopathy. N Engl J Med. 2016;375(17):1660-70.
6. Lizardi-Cervera J, Almeda P, Guevara L, Uribe M. Hepatic encephalopathy: a review. Ann Hepatol. 2003;2(3):122–30.
7. Salerno F, Merli M, Cazzaniga M, et al. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol. 2002;36(4):494–500.
8. Pithawa AK. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: pathophysiology, diagnosis, management. Med J Armed Forces India. 2007;63(2):205.
9. BDSS Corp. Released 2020. coGuide Statistics software, Version 1.0, India: BDSS corp. Available from: https://www.coguide.in. [Last accessed on 2021 Aug 05].
10. Sharma P, Sharma BC. Management Patterns of Hepatic Encephalopathy: A Nationwide Survey in India. J Clin Exp Hepatol. 2015;5(3):199–203.
11. Romero-Gómez M, Boza F, García-Valdecasas MS, García E, Aguilar-Reina J. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. Am J Gastroenterol. 2001;96(9):2718–23.
12. Saunders JB, Walters JR, Davies AP, Paton A. A 20-year prospective study of cirrhosis. Br Med J (Clin Res Ed). 1981;282(6260):263–6.
13. Jepsen P, Ott P, Andersen PK, Sørensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51(5):1675–82. 14. Tariq M, Iqbal S, Khan NU, Basri R. Precipitating factors of hepatic Encephalopathy. Rawal Med J. 2009;34(1):95–7.
15. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397–417.
16. Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: A critical review and practical guidance. World J Hepatol. 2016;8(6):307–21.
17. Gupta DV, Shah K, Solanke D, Ingle M, Sawant P. Predictors of minimal hepatic encephalopathy in patients with cirrhosis and predictors of overt hepatic encephalopathy in patients with minimal hepatic encephalopathy. J Hepatol. 2016;64(2):256–7.
18. Udayakumar N, Subramaniam K, Umashankar L, Verghese J, Jayanthi V. Predictors of mortality in hepatic encephalopathy in acute and chronic liver disease: a preliminary observation. J Clin Gastroenterol. 2007;41(10):922–6.
19. Sasidharan A. Outcome and predictors of mortality in severe hepatic encephalopathy. J Clin Exp Hepatol. 2013;3(1):S41.
20. Dhanunjaya Y, Anand U, Anand C. A study of plasma D-dimer levels in various stages of liver disease. J Liver. 2013;2(2):1.
21. Khoury T, Ayman AR, Cohen J, et al. The Complex Role of Anticoagulation in Cirrhosis: An Updated Review of Where We Are and Where We Are Going. Digestion. 2016;93(2):149–59.