Luis & Nat Hepatic Encephalopathy

Hey guys, louise and I will be presenting hepatic encephalopathy

first. We will break it down and let you know exactly what H. E. Is.

Hey guys

hee is a serious complication of liver disease and porto systematic shunting

that represents a continuum of

neuropsychiatric changes and altered consciousness.

There are three types of a.g.

Type A which is caused by acute

liver failure,

Type B,

which is caused by Porto systematic something

and type C,

which is caused by cirrhosis

Progression of CHD two Ohe and its impact the quality of life. Make it early.

It's early diagnosis imperative.

Come on

and Patel physiology is next

One of the most debilitating complications of cirrhosis.

Encephalopathy affects 30-45% of Sera Ticks.

In addition to significantly affecting the

lives of patients and their caregivers.

It is also associated with increased morbidity and mortality

as well as significant utilization of healthcare resources.

The path of physio of H. E.

Is multifactorial and involves agents such as ammonia inflammatory cytokines.

Mag unease

deposition in the basal ganglia and benzodiazepine like compounds

patients with cirrhosis

in patients with cirrhosis, liver dysfunction,

impaired hepatic metabolism of ammonia

and portal hypertension results in shunting

of ammonia rich portal blood to

the systemic circulation without any detoxification

in the brain,

ammonia crosses the blood brain barrier and is metabolized by glutamine.

The accumulation of glutamine is what has actually created

this cerebral dysfunction seen in patients with H.

E.

Furthermore overt hee has been associated with

elevated ammonia levels and recent studies suggest

that various interactions with gut microbiota can play a crucial role role in H.

E.

Triggers for H. E. Include alcohol.

Use certain drugs that affect the nervous system,

constipation, dehydration or electrolyte imbalance,

digestive tract bleeding, infection, kidney disease and liver shunt

symptoms of

H. E.

Include anxiety or irritability,

cognitive impairment,

coordination or balance problems,

difficulty concentrating or short attention span,

flapping, hand motions,

mood or personality changes

and muscle twitches.

There are ways to prevent

H. E.

And includes avoiding alcohol which damages your liver cells,

avoiding medications that affect the nervous system,

eating a nutritious diet, exercise and maintaining a healthy weight.

Taking your medications as your doctor prescribes to treat

liver disease and undergoing regular liver function tests.

So we have a couple of interventions for you guys.

The first is modern patients electrolytes and fluid balance.

The rationale here is patients with HIV who are given

bicycle rides are expected to have more frequent

bowel movements due to removal of ammonia,

be the G.

I. Tract.

The next one

is modern patients neurologic status

and the reason for that is because hee experienced difficulties and numerous

mental processes all of which increase the patient's risk of falling.

The 3rd 1 is the minister like pillows and antibiotics is ordered.

This is pretty self explanatory it's server. Simona build up entry A. G.

Number four

is modern patients, tools for indications of gi bleed

mm hmm.

Hee is often preceded by G.

I bleeding unless you want to make sure that you catch the sign early so you know when

he might be coming on

monitoring our patient's vital signs is

important because since it affects neurological system's ability to regulate

breathing, heart rate and blood pressure.

You want to turn the patient often in order to prevent circulatory problems

and encourage patients cough,

practice breathing exercises and use the census barometer to assist her

in pulmonary disease and make her concurrently with the liberties.

Next we will go into treatments of H. E.

There's medical and surgical treatments.

Medical includes laxatives like Laclos, antibiotics such as neo missin, peril,

Mixon,

vancomycin and metronome basil. I did not pronounce this correctly.

But those are the

surgical treatments include um the possible chance of needing

a liver transplant and that's in severe cases.

People with hepatic encephalopathy can slow or stop or reverse

the disease by sticking to their prescribed treatment plan,

diagnosis of a. G. Occurs secondary to liver disease.

Thus patients generally also have diagnostic tests done on the liver,

such as an ultrasound, a cT scan or Emma.

All right. And even a liver biopsy.

Also an effort must be made throughout other causes

for altered mental status is a systematic infection,

medication related adverse effects hypoglycemia

and psychiatric disorders etcetera.

There are a lot of tests that women utilized to diagnose A. G.

So I'll only cover if you hear the rest can

be found that references listed on the reference page.

Yeah.

The West Haven criteria known as a cone score is based upon impairment

and consciousness is also the gold standard for medical diagnosis for a G.

There's also a couple of paper tests such as

the

phds.

The combination of N. C. T. A. N. C. T. B. D. S. T. And B. T. D. And the rebounds.

The advantage of these is that they're

based in US norms

and this way people are more used to the test type of taking they might see there

there's also computerized test.

These do not require psychologists, psychologists. Uh

So they are simple to give.

There's even an app called the Strip app and that could be given on a mobile platform

even at that even in the home setting as we know of Kobe.

Nowadays that's very frequent.

Finally it's important to note that th is

diagnosed clinically based on two types of symptoms,

impaired mental status is

as defined by the West Haven criteria and impaired neurological function.

The current standard grading

is based on clinical diagnosis,

thorough history and physical exam are imperative.

Alright and last we'll show you our patient pamphlet

and here is the

front and the back.

So on the left hand side we have quick tips when you

should have to call your doctor and quick tips on diet and

lifestyle changes which to note foods high in proteins release a lot

of ammonia when digested and should be restricted from an HCG diet.

There are also questions that you should ask your doctor if you are

diagnosed with hee like how is the liver disease affecting your body.

We have patient resources in the center

including an address and contact us information.

Then I'll go back to

the inside of the pamphlet.

On the left hand side of the pamphlet. It discusses what H. E.

Is and who are at high risk for getting H. E. In the middle.

It explains signs and symptoms and on the right hand side includes a

brief synopsis of treatments that you can get when you have H.

E.

And now it's time for our quiz. We'll go to the N. Clecs quiz

And question # one

Question # one is a patient is

admitted with hepatic encephalopathy secondary to cirrhosis.

Which meal option selection below should be avoided with this patient.

Is it a beef tips tips and broccoli rape, rape? I said that wrong

be pasta noodles and bread,

sea cucumber sandwich with a side of grapes

or d fresh salad with chopped water chestnuts.

The answer is a beef tips and broccoli rape.

And the reason behind that is because you don't want to have

a diet that is too much protein has digesting protein releases amino acids

And Question # two.

A nurse is caring for a patient with a

paddock encephalopathy while making the initial shift assessment.

The nurse notes that the patient has a flapping tremor of the hands.

The nurse should document the presence of what sign of liver disease

a palmar erythema

be construction, allow

xIA

See asterix is

and or D feeder. Hepatic across

the answer is c

asked her exists and I probably just butchered that word. I apologize.

And the 3rd and Final Question,

the healthcare provider orders lactose for

a patient with hepatic encephalopathy.

The nurse will monitor for effectiveness of

this medication for this patient by assessing what

we have. A decreased ammonia levels.

Be relief of constipation, see relief of ab pain or d decreased liver enzymes.

The answer is a decreased ammonia levels. I hope this one didn't trick you up

because I know

that the increased liver and science seems like a tempting option.

But that is what causes

A. G.

Hope you guys had fun

And I hope you guys learned a lot about 80.

And then last we have our references right here on the bottom left.

Thank you guys. I hope you enjoyed learning about hepatic encephalopathy.

Luis & Nat Hepatic Encephalopathy

Chapters

Audio TranscriptAuto-generated