الفهرس 
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Abstract
This audit was conducted at the ICU of Tropical Medicine and Gastroenterology department of Assiut University Hospital on one hundred patient admitted with hepatic encephalopathy to identify the precipitating factors, different modalities of treatment received by the patients, their efficacy and to compare these parameters with the international guidelines to achieve the best use of hospital resources and get the maximum benefit to the patient.
Seventy two patients were males (72%) and 28/100 patients (28%) were females with age mean 65.26 ±13.33 years. Eighty one patients (81%) were admitted in the ward while the others were admitted in the ICU. HTN presented in 12/100 patients (12%), DM in 72/100 patients (72%), and IHD in three patients while 13/100 patients (13%) had no comorbidities.
The condition was precipitated by diarrhea in 10/100 patients (10%) and by constipation in 20/100 patients (20%) while diuretics overdose was the only factor presented in 27/100 patients (27%). Twenty six patients (26%) were suffered from infections while protein diet in 7/100 patients (7%). No precipitating factor was detected in10/100 patients (10%).
According the lines of therapy of the studied patients, in addition to treatment of the precipitating factor if present only 14/100 patients (14%) were treated with only disaccharides where their encephalopathy grade was II according to West Haven classification while the rest of patients (86%) were treated with all main lines of therapy including enemata, disaccharide, branched chain amino acids and locally acting antibiotics whatever the grade.
This audit recommend the following for management and control of HE :
1. Hepatic encephalopathy is a relatively preventable complication of liver cirrhosis through control of precipitating factors & the use of prophylactic anti-encephalopathy measures.
2. The use of laxative disaccharides drugs such as lactulose& lactitol give good results in improvement of early stages of encephalopathy stage 1 &stage 2.
3. The use of combined treatment in the form of disaccharides ,enemata ,LOLA& BRCAA give good results in improvement of advanced encephalopathy grade 3&4 according to west haven criteria.
4. Precipitating factors such as constipation, diarrhea ,GI bleeding and infections should be promptly controlled and treated befor and together with treatment of encephalopathy itself.