1、Hepatic Encephalopathy（HE）,Dong Xuan,第一页，共二十页。,Parts,DefinitionCausesHypothesisSymptoms and SignsExaminationsTreatment,第二页，共二十页。,severe liver diseases.,metabolic disorder,central nervous system disorder,main clinical symptoms,disturbance of consciousness,behavior disorder,coma,points,第三页，共二十页。,Defin
2、ition,HE is a complex,potentially reversible disturbance in central nervous system that occurs as a consequence of severe liver diseases.,第四页，共二十页。,Causes,MainCirrhosis Severe hepatitis Fulminant liver failure Severe biliary infection Acute fatty liver of pregnancy period 70%caused by cirrhosis,第五页，
3、共二十页。,Precipitating factors of HE,1)Gastrointestinal Bleeding2)Abuse of sedatives and narcotic3)Massive paracentesis and excessive diuresis4)Infections,Hypovolemia,shock,hypoxia,Protein breakdown,Ammonia production,benzodiazepines and barbiturates,Fluid or electrolyte abnormalities and acid base dis
4、turbance,tissue breakdown,第六页，共二十页。,Several main hypotheses,Ammonia IntoxicationFalse NeurotransmittersAmino Acid imbalanceThe Gamma-Amino butyric Acid hypothesis,第七页，共二十页。,Symptoms,(prodromal stage)Slightly altered mood or behaviors(precoma stage)Somnipathy and inappropriate behaviors(lethargic sta
5、ge)Drowsy and psychopath(coma stage)Deep coma,central nervous system,Four stages of hepatic encephalopathy,第八页，共二十页。,第九页，共二十页。,Flapping tremor,Patient B.Doctor and patient,第十页，共二十页。,Classification,Level Mental Status Flapping tremor Slightly Weak positive Somnipathy and Positive inappropriate Drowsy
6、 and Positive psychopath Deep coma Negative,第十一页，共二十页。,Examinations,1)Blood ammonia chronic()acute()2)EEG slow small value3)Psychometric test Advantages:simple,no equipment Disadvantage:influenced by age and education,第十二页，共二十页。,Number connection test,第十三页，共二十页。,Graphics connection test,第十四页，共二十页。,I
7、maging examination(CT or MRI),Acute HE:Cerebral edema Chronic HE:Encephalatrophy,第十五页，共二十页。,Critical fricker-fusion frequency,Through testing the retinal glial cell lesion to judge the brain astrocytes have swellingAdvantages:sensitive,simple and reliable,第十六页，共二十页。,Treatment,Principles1）Eliminating
8、 or correcting precipitating factors2）Reducing plasma ammonia and other toxin3）Correcting plasma amino acid imbalance and supplying normal neurotransmitters,第十七页，共二十页。,4)Improving hepatocyte functions5)Liver transplantation,第十八页，共二十页。,Thank you,第十九页，共二十页。,内容(nirng)总结,Hepatic Encephalopathy（HE）。1)Gastrointestinal Bleeding。Hypovolemia,shock,hypoxia。The Gamma-Amino butyric。Critical fricker-fusion frequency。5)Liver transplantation。you,第二十页，共二十页。,
