肝性脑病的诊治ppt课件.pptVIP

* * Evolution of HE H 28 Full blown hepatic encephalopathy is a severe condition. However, the syndrome often develops slowly and patients in the early stages may only experience sleep disturbances and alterations of mood. This slide shows the typical neurologic and psychiatric symptoms occuring with the development of HE. * * * Neurophysiologic tests H 31 EEG recordings reveal a general slowing of the background activity and replacement of the normal 9-12 cycles/second waves by j waves, triphasic waves and d waves, the latter showing only 2-3 cycles/second. See slides 32 and 33 for examples. These changes are not specific, as other metabolic encephalopathies and psychotropic agents can induce similar alterations. The EEG changes therefore have a low sensitivity in HE. Integrated electrical responses to standardized stimuli can be used to evaluate afferent pathways and the cerebral cortex. Visual, auditory or somatosensory stimuli can be used. Results are expressed as time (in milliseconds) to positive (P) or negative (N) deflections in recorded EEG leads. For patients with suspected subclinical encephalopathy `endogenous event related potentials′ may be used. In this test, two aspects are combined: visual or acoustic signals are presented and in addition the patient is asked to identify a predefined stimulus. In our experience, the prolongation of the P300 latency to accoustic stimuli is a valuable test in minimal hepatic encephalopathy, as shown in slides 34, 35 and 36. * * * Specific strategies H 57 Summarizing the literature on treatment of Hepatic encephalopahy current therapeutic strategies for the three most common situations can be outlined. In acute liver failure hepatic encephalopathy may be life threatening and all efforts must be undertaken to lower ammonia levels. Protein restriction is necessary in most cases. Bowel cleansing with lactulose containing enemas, adequate glucose administration to prevent additional hypoglycemic encephalopathy and elimi