Hepatic encephalopathy
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
- mood disturbances
- sleep disturbances
- motor disturbances
- advanced neurological deficits
Outros fatores diagnósticos
- asterixis
- palmar erythema
- spider angiomata
- peripheral oedema
- jaundice
- hepatomegaly
- ascites
Fatores de risco
- hypovolaemia
- gastrointestinal bleeding
- constipation
- excessive protein intake
- hypokalaemia
- hyponatraemia
- metabolic alkalosis
- hypoxia
- sedative use
- opioid use
- diuretic overdose
- hypoglycaemia
- infection
- hepatic or portal vein thrombosis
- portacaval shunt
- renal impairment
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- liver function tests
- serum glucose
- coagulation profile
- serum electrolytes
- urea and creatinine
- arterial or venous blood gas
- FBC
- inflammatory markers (e.g., CRP)
- thyroid-stimulating hormone
- blood alcohol level
- blood ammonia level
- urine culture
- blood culture
- urine toxin screen
- ultrasonography
- head CT or MRI scan
Investigações a serem consideradas
- EEG
- lumbar puncture
- abdominal paracentesis
Algoritmo de tratamento
all patients
previous/recurrent episode
Colaboradores
Autores
Jasmohan S. Bajaj, MD, FAASLD, FACG, AGAF, FRCP (London), MS
Professor of Medicine
Department of Internal Medicine
Division of Gastroenterology, Hepatology and Nutrition
Virginia Commonwealth University and Central Virginia Veterans Healthcare System
Richmond
VA
Declarações
JB’s institution has received research support from Bausch, Grifols, Cosmo, and Sequana.
Agradecimentos
Dr Jasmohan Bajaj would like to gratefully acknowledge Dr Emily Speelmon, Dr Robert Hyzy, and Dr Meilan Han, previous contributors to this topic.
Declarações
ES, RH, and MH declare that they have no competing interests.
Revisores
Sammy Saab, MD, MPH, AGAF
Professor of Medicine
Department of Internal Medicine and Surgery
David Geffen School of Medicine
UCLA
Los Angeles
CA
Declarações
SS is a member of the speaker bureau and advisory board for Salix.
Jorge A. Marrero, MD
Assistant Professor of Medicine
Division of Gastroenterology
University of Michigan
Ann Arbor
MI
Declarações
JAM declares that he has no competing interests.
Referências
Principais artigos
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 Aug;60(2):715-35.Texto completo Resumo
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of hepatic encephalopathy. J Hepatol. 2022 Sep;77(3):807-24.Texto completo Resumo
Bajaj JS, O'Leary JG, Lai JC, et al. Acute-on-chronic liver failure clinical guidelines. Am J Gastroenterol. 2022 Feb 1;117(2):225-52.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Brain tumours
- Subdural haematoma
- Acute stroke
Mais Diagnósticos diferenciaisDiretrizes
- Clinical practice guidelines on the management of hepatic encephalopathy
- Acute-on-chronic liver failure clinical guidelines
Mais DiretrizesCalculadoras
MELDNa scores (for liver transplantation listing purposes, not appropriate for patients under age 12 years) (SI units)
Child Pugh classification for severity of liver disease (SI units)
Mais Calculadoras
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