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العنوان
Electrolytes Disturbance and Trace Elements Changes in Different Stages of Hepatic Encephalopathy /
المؤلف
Moussa, Rola Mostafa Mahmoud.
هيئة الاعداد
باحث / Rola Mostafa Mahmoud Moussa
مشرف / Ahmed Shawky El-Swaby
مشرف / Amir Helmy Samy
مناقش / Maha Mohsen Mohamed Kamal
الموضوع
Hepatic Encephalopathy.
تاريخ النشر
2015.
عدد الصفحات
140 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
الكبد
تاريخ الإجازة
1/1/2015
مكان الإجازة
جامعة عين شمس - كلية الطب - Internal Medicine
الفهرس
Only 14 pages are availabe for public view

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from 140

Abstract

In the 1950s, several reports enumerated the numerous abnormalities of mentality in patients with liver disease, and confirmed the previously enunciated theory that metabolic impairment is the underlying mechanism behind hepatic encephalopathy, and that the nitrogen-rich compounds originate from the intestine have great role in it.
Psychometric tests are highly attractive as diagnostic screening tools for HE because they are relatively inexpensive and sensitive but are only effective for the detection of lower grades of HE and results may be influenced by age and education level.
West Haven criteria comprised four grades of hepatic encephalopathy, ranging from grade 1 (which includes symptoms such as a trivial lack of awareness) through to grade 4 (which implies an unresponsive patient in a coma).
This scale demonstrated substantial variability between observers in their assessments of low grades of HE and therefore further ways of diagnosis must be established to overcome individual bias.
The treatment of the patient with hepatic encephalopathy includes treatment for the acute event and the subsequent management following recovery. This includes identifying the precipitating event and providing supportive care until there is improvement of mental status.
The development of early HE carries a poor prognosis with a one year survival of 40% only. Appropriate candidates should be referred to transplant centers after the first episode of encephalopathy of any type. Both acute and chronic HE, once advanced to stage 4 (coma), is associated with an 80% overall mortality rate so, early detection of cases with early stages of HE may be of benefit for patient survival rate
The study was conducted in Ain Shams University hospitals and El Galaa Military hospital in internal medicine department in between January 2013 to March 2014; it included 5 groups of subjects:
Control Group (A):15 patients with compensated liver cirrhosis.
Diseased Group (B): 60 patients with hepatic encephalopathy, sub divided according to weast heaven criteria into 4 group
(4 grades of HE)
Group (B1): 15 patients with grade 1 HE.
Group (B2): 15 patients with grade 2 HE.
Group (B3): 15 patients with grade 3 HE.
Group (B4): 15 patients with grade 4 HE.
The included subjects (the 5 groups), underwent full history taking, general and local examination, routine laboratory investigations, and special electrolytes and trace elements examination and were subjected to MELD and Child Pugh scoring.
The results of the study showed that there was statistically significant difference between different stages of hepatic encephalopathy as regard level of sodium, potassium, zinc and magnesium. There was also statistically significant positive correlation between MELD and CHILD score in different grades of hepatic encephalopathy.
There was statistically significant negative correlation between electrolytes, trace elements and CHILD scores in patients with late stages of hepatic encephalopathy while there was no correlation with MELD score.
A cut off value was obtained for different electrolytes and trace elements in grade 1 and grade 4 of hepatic encephalopathy which may be helpful in diagnosis and grading of encephalopathy.
Conclusion
Considering all that, the concentration of serum electrolytes and trace elements would have a beneficial effect on hepatic encephalopathy and maybe on progression of the disease, so it would be recommendable to provide laboratory analysis of electrolytes and trace elements as a routine.
These observations may serve to use simple, non invasive and easy serum test in order to predict different gades of hepatic encephalopathy in early and late hepatic encephalopathy.