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Hepatic encephalopathy: early diagnosis in pediatric patients with cirrhosis
Naghi Dara1, Ali-Akbar Sayyari1, Farid Imanzadeh1
11. Pediatric Gastroenterology and Hepatology Department, Mofid Children Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Hepatic encephalopathy, a complication of liver disease, requires early suspicion by primary care physicians. Subtle symptoms may be missed but can be detected with specialized testing.
Area of Science:
- Hepatology
- Neurology
- Internal Medicine
Background:
- Increasing prevalence of acute liver failure (ALF) and chronic liver disease (cirrhosis) leads to more hepatic encephalopathy cases.
- Primary care physicians are crucial for early detection due to familiarity with patient's baseline status.
- Hepatic encephalopathy is a serious complication in patients with comorbidities, necessitating multidisciplinary care.
Purpose of the Study:
- To highlight the importance of considering hepatic encephalopathy in patients with ALF and cirrhosis presenting with neuropsychiatric symptoms.
- To emphasize the need for recognizing both overt and subtle forms of hepatic encephalopathy.
- To encourage proactive identification and management of potential precipitating factors in cirrhotic patients.
Main Methods:
- Clinical observation and patient history review.
- Assessment of neuropsychiatric manifestations and level of consciousness.
- Consideration of neurophysiologic and neuropsychiatric testing for subtle cases.
Main Results:
- Hepatic encephalopathy presents with a spectrum of symptoms, from coma to subtle changes like depression or decreased school performance.
- Subtle forms of hepatic encephalopathy may not be clinically apparent but are detectable through specific testing.
- All cirrhotic patients are at risk, and precipitating factors require regular clinical attention.
Conclusions:
- Hepatic encephalopathy should be suspected in patients with ALF or cirrhosis exhibiting neuropsychiatric changes.
- Early detection, including subtle forms, is vital for effective management.
- Regular clinic visits should focus on identifying and addressing potential triggers for hepatic encephalopathy.
Objective:
As acute liver failure (ALF) and chronic liver disease (cirrhosis) continue to increase in prevalence, we will see more cases of hepatic encephalopathy. Primary care physician are often the first to suspect it, since they are familiar with the patient's usual physical and mental status. This serious complication typically occurs in patients with severe comorbidities and needs multidisciplinary evaluation and care. Hepatic encephalopathy should be considered in any patient with acute liver failure and cirrhosis who presents with neuropsychiatric manifestations, decrease level of consciousness (coma), change of personality, intellectual and behavioral deterioration, speech and motor dysfunction. Every cirrhotic patient may be at risk; potential precipitating factors should be addressed in regular clinic visits. The encephalopathy of liver disease may be prominent, or can be present in subtle forms, such as decline of school performance, emotional outbursts, or depression. "Subtle form" of hepatic encephalopathy may not be obvious on clinical examination, but can be detected by neurophysiologic and neuropsychiatric testing.
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