肝性脑病英文课件

Hepatic Encephalopathy （HE） Dong Xuan Parts Definition Causes Hypothesis Symptoms and Signs Examinations Treatment severe liver diseases.metabolic disorder central nervous system disorder main clinical symptoms disturbance of consciousness behavior disorder coma poi nts Definition HE is a complex, potentially reversible disturbance in central nervous system that occurs as a consequence of severe liver diseases. Causes Main Cirrhosis Severe hepatitis Fulminant liver failure Severe biliary infection Acute fatty liver of pregnancy period 70% caused by cirrhosis Precipitating factors of HE 1) Gastrointestinal Bleeding 2) Abuse of sedatives and narcotic 3) Massive paracentesis and excessive diuresis 4) Infections Hypovolemia, shock, hypoxiaProtein breakdownAmmonia production benzodiazepines and barbiturates Fluid or electrolyte abnormalities and acid base disturbance tissue breakdown Several main hypotheses Ammonia Intoxication False Neurotransmitters Amino Acid imbalance The Gamma-Amino butyric Acid hypothesis Symptoms (prodromal stage) Slightly altered mood or behaviors (precoma stage) Somnipathy and inappropriate behaviors (lethargic stage) Drowsy and psychopath (coma stage )Deep coma central nervous system Four stages of hepatic encephalopathy Flapping tremor Patient B. Doctor and patient Classification Level Mental Status Flapping tremor Slightly Weak positive Somnipathy and Positive inappropriate Drowsy and Positive psychopath Deep coma Negative Examinations 1)Blood ammonia chronic( ) acute ( ) 2)EEG slow small value 3)Psychometric test Advantages :simple , no equipment Disadvantage: influenced by age and education Number connection test Graphics connection test Imaging examination (CT or MRI) Acute HE : Cerebral edema Chronic HE: Encephalatrophy Critical fricker-fusion frequency Through testing the retinal glial cell lesion to judge the brain astrocytes have swelling Advantages: sensitive , simple and reliable Treatment Principles 1）Eliminating or correcting precipitating factors 1.2）Reducing plasma ammonia and other toxin 3）Correcting plasma amino acid imbalan