ABSTRACT
To ascertain the spectrum of precipitating factors of hepatic encephalopathy in patients with liver cirrhosis. descriptive study. The study was conducted in the department of medicine, medical B unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar over six months. All patients with cirrhosis of liver[CL] of more than 12 years of age, manifesting signs of hepatic encephalopathy [HE] were included and those who had acute fulminant hepatitis or had noncirrhotic portal hypertension were excluded from the study. Detailed history, clinical examination and thorough investigations were done to look for any precipitating factor and the findings were recorded on a proforma. Fifty patients [32 males and 18 females] were enrolled. 47 patients had hepatitis B, C or both positive. 64% were in the age group of 45-60 years and 76% were having either grade III or IV coma. Thirty three [66%] patients had asterixis which was found to be a sensitive index for the diagnosis of HE in patients who were not in coma. Jaundice and Ascites were other common presenting features. Electrolytes imbalance in 28[56%] patients, diarrhea in 20[40%], constipation in 16[32%], infections in 12[24%] and gastrointestinal bleed in 11[22%] patients were amongst the commonest precipitating factors. None gave the history of alcoholism or recent surgery Occurrence of precipitating factors for HE in patients with CL is a common phenomenon and all such patients must be hospitalized to ascertain and manage such factors