What is hepatic encephalopathy and how to cure the disease?

1 What causes hepatic encephalopathy? This disease, which is characterized by impairments of the nonpsychic type, but the patient has problems with cognitive abilities. In addition, everything is accompanied by an acute form of hepatic insufficiency, which is caused by chronic diseases of the organ itself.

The main cause of this ailment is ammonia. It is he who is the main neurotoxic element. If a person still has a liver disease in acute or chronic form, then this only reduces the intensity of excretion of the toxin from the body. In this case, hepatic encephalopathy is endogenous in nature. In addition, other factors can accelerate the development of the disease. First, it concerns various infectious diseases, especially those that affect the gastrointestinal tract. Secondly, bleeding in the digestive organs plays an important role. Thirdly, a similar side effect can cause an anastomosis of the portocaval species, which will cause complications. In addition, the use of alcoholic beverages is more important. It is necessary to pay attention to decompensation of hepatic diseases, constipation and renal failure.

In general, the pathogenesis of the disease is not known exactly. Previously, it was believed that liver problems do not lead to violations of cognitive function, but this disease forces us to draw back conclusions. Hepatic encephalopathy with cirrhosis confirms this. Patients with hepatic encephalopathy were subjected to MRI and CT.These studies revealed that atrophy of the cerebral cortex occurs in the parietal and frontal lobes. These changes were most pronounced in people who suffer from cirrhosis of the liver. In addition, histological analysis was used. Changes in astrocytes, which are characteristic of Alzheimer's disease, were revealed. And the severity of these changes directly depended on the severity of the course of hepatic encephalopathy.

Now scientists and doctors are considering several theories about the mechanism of development of baked encephalopathy. In the first theory( and the most common), the mediator is ammonia, or rather, its neurotoxicity. This substance directly affects excitation and inhibition in the synapses. Violated regulatory processes due to changes in astrocytes. The metabolic processes of serotonin are accelerated, especially if the disease has latent flow. The second theory examines the effects of benzodiazepines and GABA.In addition, mediators can be other substances: opiates, taurine, histamine, various peptides.

2 Symptoms of the disease

According to the generally accepted classification for the course of the disease, there is acute hepatic encephalopathy and the chronic form of this disease. Spastic paraparesis and degeneration of hepatocerebral type are distinguished. In addition, the disease can be latent. If encephalopathy has a chronic form, then the course can be not only chronic, but also recurrent.

When a patient has hepatic encephalopathy, the symptoms are as follows: tremor, problems with consciousness, parkinsonism( the latter - in rare cases).It is necessary to pay attention to the increased amount of ammonium in the study of blood. The electroencephalogram changes, and there are changes for the worse in psychometric tests. In general, the clinical picture depends entirely on the stage of the development of the disease. If the patient has a hidden form, then it can be identified only after psychometric tests.

The first stage is characterized by problems in the rhythm of sleep. Sometimes the personality of a person changes slightly. Attention begins to deteriorate. Emotional manifestations gradually disappear. There are difficulties with writing and other movements that require accuracy. Asterixis appears.

In the second stage, drowsiness becomes stronger, and this condition can even cause lethargic sleep. Speech in humans is usually very monotonous at this stage, but the activity of reflexes increases. At this stage, the person becomes inhibited. He's disoriented. Asterixis is saved. This is the state in which the hands twitch. This is due to the fact that sometimes the muscle tone decreases. This phenomenon is most easily noticed in the case when the patient stretches out his arms in front of him, and places his fingers. Similar violations in motor activity can be seen when a person lowers his eyelids, pulls out his tongue or forms his lips like a pipe. But we must not forget that such a symptom is manifested not only in hepatic encephalopathy, but also in other diseases: uremia, an overdose of tranquilizers, severe diseases of the respiratory system. There is an unpleasant liver odor from the mouth.

Symptoms of the third stage are epileptic seizures, which were not previously manifested in the patient. Spastic paraplegia can develop. Consciousness is confused, there is stunnedness, clone, rigidity of hands and feet.

At the last stage the patient falls into a coma. Muscle tone can be completely absent, hands and feet will be sluggish. Usually, there is no response to stimuli, and reflexes are greatly reduced.

3 Treatment measures

Before starting treatment of encephalopathy, it is necessary to carry out diagnostics. Therapy is prescribed depending on what the patient's symptoms are. Treatment can be selected by a doctor only after examining the patient for various studies. It is necessary to conduct laboratory tests to check the level of ammonia in the body. Psychometric tests are prescribed. You can investigate the reaction speed and fine motor skills. Instrumental methods that are used for hepatic encephalopathy include: magnetic resonance spectroscopy, evoked potentials and electroencephalopathy.

Encephalopathy of the liver is treated only after the primary disease of this organ has been eliminated. In addition, it is necessary to identify the factors provoking the disease and to eliminate their influence.

It is required to abandon all tranquilizers. It is necessary to reduce the consumption of substances that are suspected of causing toxic effects on the brain. By the way, some substances that have such an effect are formed in the human body when proteins break down in the intestine. In this regard, it is necessary to reduce the intake of proteins, and also to clean the intestines as possible( especially if the patient often has bleeding in this organ).

Usually start with enemas. A solution of polyethylene glycol with the addition of electrolytes is prescribed. However, with hepatic encephalopathy, it is necessary to clear the intestine not only from food debris, but also from microorganisms that are responsible for the breakdown of the protein. To eliminate bacteria, antibiotics will be required. For example, prescribe Vancomycin, Neomycin, Metronidazole.

Patient may be given amino acid mixtures.

However, this method is used even when other methods have not helped. Doctors and scientists suggest that a major role in the development of the disease is the lack of zinc in the body, so that medications that contain zinc are prescribed. Improvement is also noted after the use of benzodiazepine receptor blockers. For example, doctors appoint Flumazenil.

Drug therapy necessarily includes the use of drugs that reduce the formation of ammonia in the intestine. For example, lactulose is suitable. If the patient has a severe form of the disease, then the substance is injected with a probe. If lactulose is ineffective, then antibiotics are prescribed. It is also necessary to use medicines that will neutralize ammonia.

As for surgical treatment, the surgeon can perform portocaval shunting. This procedure reduces the manifestation of encephalopathy. Doctors can perform liver transplantation. This option is appointed only in the case when drug therapy did not give a positive result. The rehabilitation period takes a lot of time. However, it is not always possible to conduct operations.

4 Useful advice for

What is hepatic encephalopathy, every person should know. This disease is directly related to hepatic insufficiency in a chronic form. As soon as the first symptoms are visible, you need to urgently go to the hospital for complete diagnosis and selection of appropriate treatment.