Common Causes of Hepatic Encephalopathy at Govt. Teaching Hospital Shahdara

Abstract

Aim: To see the common aggravating factors of hepatic encephalopathy in Govt Teaching Hospital Shahdara, Background: Hepatic encephalopathy is very common complication of decompensated liver disease and is a syndrome with neurological and psychiatric symptoms, which may be precipitated by constipation, upper GI bleed, infection, use of sedatives, recent paracentitis, electrolyte imbalance, acute viral hepatitis over CLD. Study design: It is a cross sectional observational study. Method: First 100 patients with hepatic encephalopathy after taking consent were included in the study. While diseases causing similar symptoms like stroke, meningoencephalitis, brain tumor or head trauma were excluded. Results: Out of 100 patients, 92 were males, and 8 were females. Their mean age was 41 with age range of 35+_12 years. In 97% patient’s hepatitis c was the culprit agent. While in 3% hepatitis B and C both were involved. We found out the aggravating factors of hepatic encephalopathy by taking proper history and excluded the similar diseases by appropriate investigation like CT brain and Lumber puncture etc. In 82% patients, we found combination of constipation and acute viral insult over chronic liver disease.11% cases were identified to have spontaneous bacterial peritonitis as main factor of hepatic encephalopathy, 3% cases were with constipation alone, while 2% were having upper GI bleed as causative agent. While 2% died without any identifiable factor. Conclusion: Most of patients with hepatic encephalopathy were those in which there were more than one factors i.e. constipation and acute viral insult, then SBP, constipation, and upper GI bleed in descending order in GTHS. So perhaps by taking vaccination against hepatitis A and hepatitis B and preventing constipation and prophylactic endoscopy and banding may prevent hepatic encephalopathy at GTHS. All the common factors are preventable by proper awareness programs, and a hepatitis clinic will be very effective in reducing the incidence of hepatic encephalopathy by creating awareness amongst people, which is unfortunately lacking at GTHS.