7
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
Hepatic encephalopathy (HE) is a frequent complication of liver dysfunction, including acute liver failure and cirrhosis.
HE presents with a sHEctrum of neuropsychiatric symptoms ranging from mild cognitive impairment to coma. The
diagnosis of HE is based on the characteristic anamnestic, clinical and paraclinical findings and requires the exclusion
of other causes of encephalopathy . Psychometric tests are widely used in clinical practice for the early diagnosis of
HE: number-letter, number- line, handwriting, arithmetic etc. The sensitivity of psychometric tests in detecting HE is
70-80%. Although less severe, patients with minimal hepatic encephalopathy are at significant risk for impaired quality
of life, including increased hospitalisation and progression to manifest HE. The main aim of our study is to compare
and evaluate the extent and dynamics of HE in patients with cirrhosis before and after inpatient treatment.
KEYWORDS
Liver cirrhosis, hepatic encephalopathy, blood ammonia, hospital treatment.
Research Article
ASSESSMENT OF THE DYNAMICS OF HEPATIC ENCEPHALOPATHY IN
PATIENTS WITH CIRRHOSIS BEFORE AND AFTER IN-HOSPITAL
TREATMENT
Submission Date:
February 27, 2022,
Accepted Date:
March 17, 2022,
Published Date:
March 29, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue03-02
Bekmuradova Makhsuda Salkhidinovna,
Department of Propaedeutics of Internal Diseases, Samarkand State Medical Institute, Uzbekistan
Khaydarov Sanjar Nizomitdinovich
Department of Propaedeutics of Internal Diseases, Samarkand State Medical Institute, Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
8
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
INTRODUCTION
Hepatic
encephalopathy
(HE)
is
a
frequent
complication of liver dysfunction, including acute liver
failure and cirrhosis. HE presents a totality of
neuropsychiatric symptoms ranging from mild
cognitive impairment to coma. It is a significant
morbidity factor in patients with liver disease. HE is
frequently seen in cirrhosis. Hepatic encephalopathy is
classified as types A, B and C, respectively. HE can also
be classified according to whether its presence is overt
or covert. The pathogenesis is related to the
production of ammonia and glutamine, and treatment
is based on mechanisms that reduce the formation
and/or removal of these compounds. All forms of HE
and their manifestations are reversible.
Hepatic encephalopathy (HE) is a hallmark of liver
failure and affects up to 40% of patients with cirrhosis.
It is defined as a multifactorial neuropsychiatric
disorder manifesting a wide collectively of cognitive
impairment and neuromuscular dysfunction. HE is a
significant cause of repeated hospital admissions in
cirrhotic patients and seriously affects quality of life in
both patients and caregivers. It is a marker of poor
prognosis in patients with cirrhosis, with a reported
survival rate of only 36% 1 year after first presentation.
There is no specific diagnostic test for HE, and the
diagnosis is based on clinical suspicion, excluding other
causes and the use of clinical tests that can confirm its
diagnosis. Many tests have been used in trials and
experiments, but are not yet universally accepted
[3,7,17].
The diagnosis of HE is based on the characteristic
anamnestic, clinical and paraclinical findings and
requires the exclusion of other causes of
encephalopathy [8,11]. Psychometric tests are widely
used in clinical practice for the early diagnosis of HE:
number-letter, line, handwriting, arithmetic, etc. The
sensitivity of psychometric tests in detecting HE is 70-
80%.
Patients usually present to primary and secondary care
services with complications such as HE, with or without
a prior diagnosis of chronic liver disease. There is also a
milder form of the disease, latent or minimal hepatic
encephalopathy (MHE) or latent encephalopathy with
little change in cognitive function. Despite the less
severe form, patients with MHE are at significant risk
of a deterioration in quality of life, including increased
hospitalisation and progression to manifest HE.
AIM OF THE STUDY
To compare and evaluate the degree and dynamics of
HE in patients with cirrhosis before and after in-patient
treatment.
MATERIAL AND METHODS OF INVESTIGATION
The research was carried out in the 1st Clinic of the
Samarkand State Medical Institute, the 2nd
Department of Internal Medicine. A total of 35 patients
with cirrhosis of various genesis like hepatitis B, C, D,
alcohol, autoimmune and cryptogenic took part in the
research. The patients were examined and treated in a
therapeutic department. Exclusion criteria: mental
illness, cerebrovascular disease.
9
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Table 1.
Etiologyofcirrhosis
Numberofpatients (n)
(%)
Hepatitis C
10
28,6%
Hepatitis В
9
25,7%
Hepatitis В, D
3
8.6%
Alcoholic
2
5,7%
Fattyhepatosis
7
20%
Autoimmune
1
2,9%
Cryptogen
3
8,5%
The severity of cirrhosis in all patients was assessed
according to the Child-Tercott-Pugh classification. The
grade of cirrhosis was based on the sum of all scores.
All patients underwent a complex of investigations,
such as: general blood count, urine, blood
biochemistry, liver ultrasound, liver elastography, liver
fibroscopy,
esophagogastroduodenofibroscopy
(EGDFS), ammonia in blood.
To assess the severity of HE, the following were used:
1) psychometric test (a number binding test (Reitan
test) was used as a psychometric test; 2) West-Haven
criteria for hepatic encephalopathy as modified by
Conn (1994).
In assessing the severity of hepatic encephalopathy, a
questionnaire and a "Number Binding Test" to test the
ability to connect numbers from 1 to 25 in a correct
sequence over a period of time was used.
RESULTS OF THE STUDY AND DISCUSSION
Of the patients examined 20 (57.2%) were male and 15
(42.8%) were female. Minimum age was 32 years.
Maximum age was 64 (mean age was 49 ± 8.2). Based
on the data of laboratory tests and clinical
observations the group of patients (35 patients) was
divided into 3 subgroups according to the severity of
cirrhosis according to Child-Pugh classification. Group
10
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
A included 18 (51,5%) patients, Group B - 13 (37,1%),
Group C - 4 (11,4%) patients.
The results were: 1) before ongoing treatment: 0
(latent HE) was detected in 8 (22.9%) people the
average time to pass the test was 58.4 s, 1 degree in 19
(54.3%) people the average time to pass the test was
82.8 s, 2 degree in 7 (20%) people the average time to
pass the test was 111.9 s, 3 degree in 1 (2.8%) person due
to severity of the patient could not pass the test; 2)
after ongoing treatment (diet - table 5, drug therapy -
lactulose, preparations of ursodeoxycholic acid, very
cautiously branched amino acids, L-ornithine-
Laspartate, vitamins, antibacterial agents - Rifaximin).
After the test, out of 35 patients: grade 0 (latent HE) -
11 (31.4%) people, mean time to pass the test was 58.1
seconds, grade 1 - 18 (51.4%) people, mean time to pass
the test was 81.4 seconds, grade 2 - 5 (14.3%) HEople,
mean time to pass the test was 112.1 seconds, grade 3 -
1 (2.9%) people, but could not pass the test because of
disorientation.
Results of investigation: after in-patient treatment
average time of test passing 0 degree (latent) 8 (22,9
%) people, average time of test passing was 58,4 sec, 1
degree - 19 (54,3 %) people, average time of test
passing was 82,8 sec, 2 degree - 7 (20 %) people,
average time of test passing was 111,9 sec, 3 degree - 1
(2,8 %) people, average time of test passing was 190,2
sec. The majority of patients with cirrhosis showed a
reduction in the severity of HE symptoms
(psychomotor
retardation
and
difficulties
in
performing everyday activities, altered level of
consciousness and disorientation, as well as sleep-
wake cycle disorders, personality changes, motor
system
disorders,
including
hypertension,
hyperreflexia, dystonia, dyskinesia, plantar muscles
lifting and asterixis) during inpatient treatment.
CONCLUSIONS
HE is a totality of neurological and psychiatric disorders
from subclinical manifestations to coma. All patients
with hepatic cirrhosis who have been in-patients of
Department 1 of Samarkand State Medical Institute
had hepatic encephalopathy of varying severity, from
mild to severe. Hepatic comaor the 4th degree of
hepatic encephalopathy was not diagnosed in any
patient, because the 4th degree of hepatic
encephalopathy was not hospitalised in a therapeutic
department, as this condition is considered intensive
care. During inpatient treatment, most patients'
psychometric test time decreased and their
neurological and mental status improved, indicating
that the severity of HE has regressed against the
background of treatment and that the therapies used
were effective.
REFERENCES
1.
Atluri
D.K., Asgeri M., Mullen
K.D. Reversibility
of
hepatic
encephalopathy
after
liver
transplantation // Metab Brain Dis. – 2010. – №
25. –Р. 111 113.
2.
Damulin
I.
Pechenochnayaentsefalopatiya:
patogenez,
klinika,
lechenie
[Hepatic
encephalopathy:
pathogenesis,
clinic,
treatment] // AtmosferaNervniebolezni. –
2008. – № 1. – Р. 8 14.
3.
Polunina
T.,
Maev
I.
Pechenochnayaentsefalopatiya.
Algoritmdifferentsial’noidiagnostikii
taktikavedeniya [Hepatic encephalopathy.
Algorithm of differential diagnostics and
tactics of reference] // RMZH. – 2010. – № 5, 291
p.
4.
Polunina
T.,
Maev
I.,
Polunina
E.
Gepatologiyadlyaprakticheskogovracha
11
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
[Hepatology for a practicing physician]. M.:
AvtorskayaAkademiya, 2009. – 350 p.
5.
Salerno F., Camma C., Enea M., Rossle M.,
Wong
F.
Transjugular
intrahepatic
portosystemic shunt for refractory ascites: a
meta-analysis of individual patient data //
Gastroenterology. – 2007. – Vol. 133 (3). – Р. 825
834.
6.
Klinicheskierekomendatsii
EASL:
transplantatsiyapecheniEvropeiskayaassotsiat
siya po izucheniyupecheni (EASL) [Clinical
recommendations EASL: liver transplantation
European Association for the Study of the liver]
// Journal of Hepatology. – 2016. – Vol. 64. – Р.
433 485.
7.
Бекмурадова М. С., Холтураев А. Т.,
Гаффаров Х. Х. Влияние ингибиторов
протонной помпы на степень развития
печеночной энцефалопатии //Достижения
науки и образования. – 2020. – №. 8 (62). – С.
88-91.[HTML] cyberleninka.ru
8.
Bekmuradova M. S., Shodieva G. R.
HELICOBACTER PYLORI WORSENING FACTOR
OF THE PATIENT'S CONDITION IN PATIENTS
WITH LIVER ENCEPHALOPATHY //Web of
Scientist: International Scientific Research
Journal. – 2021. – Т. 2. – №. 11. – С. 133-137.[PDF]
academiascience.org
9.
СамиевУ. Б., БекмурадоваМ. С. Helicobacter
pylori
УХУДШАЮЩИЙФАКТОРСОСТОЯНИЯБОЛЬН
ОГОУПАЦИЕНТОВСПЕЧЕНОЧНОЙЭНЦЕФАЛ
ОПАТИЕЙ //Scientific progress. – 2021. – Т. 2. –
№. 6. – С. 1763-1767. .[HTML] cyberleninka.ru
10.
Samiev U. B., Bekmuradova M. S. EFFECTS OF
PROTON PUMP INHIBITORS ON THE DEGREE
OF
DEVELOPMENT
OF
LIVER
ENCEPHALOPATHY IN PATIENTS WITH LIVER
CIRROSIS.[PDF] academiascience.org
11.
Шодиева Г. Р. Роль Цитокинов у больных
циррозом печени вирусной этиологии
//Вестник науки и образования. – 2020. – №.
10-4 (88). – С. 104-106.[HTML] cyberleninka.ru
12.
Khan MA, Cholankeril G, Howden CW. Proton
pump inhibitors and the possible development
of hepatic encephalopathy in cirrhotic patients:
True association or residual confounding?
Gastroenterology 2017;152:2076. [PubMed]
[Google Scholar]
13.
Vilstrup H, Amodio P, Bajaj J, et al. . Hepatic
encephalopathy in chronic liver disease: 2014
practice guideline by the American Association
for the Study of Liver Diseases and the
European Association for the Study of the
Liver. Hepatology 2014;60:715–35. [PubMed]
[GoogleScholar]
14.
Pan Z, Wu XJ, Li JS, Liu FN, Li WS, Han JM.
Functional hepatic flow in patients with liver
cirrhosis. World J Gastroenterol 2004;10:915–8.
[PMC free article] [PubMed] [Google Scholar]
15.
Bajaj
J.S.,
Schubert
C.M.,
Heuman
D.M.,
Wade
J.B., Gibson
D.P., Topaz A. Persistence of
cognitive impairment after resolution of overt
hepatic encephalopathy // Gastroenterology. –
2010. – № 138. – Р. 2332 2340.
16.
Bekmuradova M. S., Shodieva G. R.
HELICOBACTER PYLORI WORSENING FACTOR
OF THE PATIENT'S CONDITION IN PATIENTS
WITH LIVER ENCEPHALOPATHY //Web of
Scientist: International Scientific Research
Journal. – 2021. – Т. 2. – №. 11. – С. 133-137.
17.
Bekmuradova M. S., Samiev U. B. Actions of
Proton Pump Inhibitors on the Degree of
Development of Hepatic Encephalopathy in
Patients with Liver Cirrhosis //CENTRAL ASIAN
JOURNAL OF MEDICAL AND NATURAL
SCIENCES. – 2021. – Т. 2. – №. 5. – С. 437-441.
