Talk:Hepatic encephalopathy

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What other causes of hepatic encephalopathy are there that are not due to liver disease? JFW | T@lk 17:44, 9 November 2005 (UTC)

Uhh, not many - given that it's called hepatic encephalopathy. Right? JFW | T@lk 23:01, 31 March 2007 (UTC)

[edit] Addendum

Although this article is tight from a clinic standpoint and should remain as is, it lacks the human aspect of somebody who has suffered the disease and has lived to tell about it.

As far as treatment, lactulose will work to a certain degree, but not how most doctors recomend its dosage. I have found that lactulose works well when confusion and or brain swelling(headache) sets in on an as needed basis. Otherwise, any caloric and vitamin intake that is not readily processed by the weakened liver, will be flushed with the unabsorbed ammonium (NH₄⁺) and will result in unhealthy weight loss and a weakened patient.

When the article speaks of decreasing protien loss to help lessen the effect of ammonia (NH₃) buildup, this is quite true, but it fails to mention that the kind of protien that is most dangerous is animal protiens with beef being the worst offender. From what I understand, even with slight brain damge from seven years of lethal amounts of ammonia (186+) in my bloodstream before my transplant, the animal protiens cannot be broken down by a weakened liver and those protiens are made into the simplest byproduct, ammonia. Unfortunately, the human body cannot do without protien intake at all, so it is usually recomended that the patient find a more readily soluable protiens such as those found in non-animal sources and eggs. Cunsult a nutritionist and your doctor for a solution for a suitable diet plan.

As mentioned in the above article, there is a flapping tremor that is associated with this disease, but it fails to mention how closely this symptom has to be watched. Shaking hands are normal to a degree, but if the arm is fully extended with the fingertips pointing at the ceiling and the hand is flapping like somebody waving, it is a sign that the patient has very little time left as this is what is known in doctor's circles as "the wave good-bye."

Just for the record, I'd like to expand on the different "grades" of this disease, these "grades" can be mixed and matched and a symptom listed in "grade 3" can be present in "grade 2" depending on the person. As far as "amnesia" goes, there will be confusion in the patient as to what place and time they are in, but a patient lives longer with the disease (and that is quite possible), there might be a form of regression as in a 37 year old patient might wake up with the memories from 16+ years temporarily unacessable for a short period of time. This is not a good time to force feed them their true age, because the patient may become scared and violent.

Speaking of these violent "fits of rage," this is due to confusion and is usually not all that dangerous to anyone but the patient as long as the patient doesn't have access to weapons. When I say weapons, I include the patient driving vehicles. A patient with this disease does not respond well to stress since it will increase the confusion and they should NOT be allowed to drive or have access other weapons including kitchen knives. Truthfully, they shouldn't be allowed to operate any cooking appliance without supervision. I say this because a patient with this disease can be easily fixated on a fire and forget how dangerous it is.

As a final note, I'd like o make crystal clear that there are several ways to get liver cirrhosis besides alcoholism and hepatitis and in no way whatsoever should a person assume that a patient with cirrhosis brought it upon themselves. I take offense to these clinical articles always referring to alcoholism based cirrhosis an example of its symptomology. As a matter of fact, there are increasing cases of "cryptogenic" liver cirrhosis. That means that the doctors have no clue as to how or why it happened. Believe me, if it was alcoholism, it would be easily detectable. Please keep that in mind before you pass judgement on somebody fighting for their life.

You should not leave comments on the article page. The page does not in any way pass judgement on the causality of the cirrhosis. Indeed, many new cases are indeed cryptogenic (chronic active hepatitis, NASH, alpha-1 antitrypsin-related etc). I agree that the flapping tremor is used as a marker of mild encephalopathy, and I will move ahead and put this into the article.

As for your other points, the ammonia and lactulose paradigm has been shown to be of doubtful clinical relevance, and as long as constipation is avoided, cirrhotics need not be on stupendous lactulose doses. Indeed, as it is an energy-wasting state, nutrition is of vital importance.

Please offer further views as to how this article can be improved. I will try to include material on the EEG diagnosis of hepatic encephalopathy (when I'm closer to my textbooks) and hopefully some more recent reviews. JFW | T@lk 16:34, 13 December 2005 (UTC)

I've done some fixes. JFW | T@lk 16:37, 13 December 2005 (UTC)

[edit] Aftereffects

Another subject for consideration is the "after affects" of the impact. I am a liver transplant receiptant (for "crypotogenic reasons") who had a sustained two week period of major encephalopathy which was overcome by the use of lactalose (4 times a day). I suspect, even though I don't have the confusion issues to deal with, that I do have some dimunition of mental ability -- and maybe it is strictly because of age in combination with the remants of the disease. The changes are not dramatic to the rest of the world -- and maybe not evident to them -- but I can detect a change. Small loses of cognitive ability. I was involved in a research project during my disease to check the relationship of a possible link to "hemocromotosis". It would be interesting to continue the testing now, to see the relationship of my answers now -- to then.75.34.95.100 17:38, 24 January 2007 (UTC)

Hemochromatosis you meant undoubtedly.

I'm not sure if I understand what you mean. Are you suggesting that the episode of encephalopathy caused lasting damage? That is hard to demonstrate, given that HE is a diffuse process. JFW | T@lk 23:01, 31 March 2007 (UTC)

[edit] Early studies

PMID 429564 shows how ammonia is "trapped" in the brain. JFW | T@lk 23:01, 31 March 2007 (UTC)