Hepatic encephalopathy; Precipitating factors in patients with cirrhosis

gujri@hotmail.com Hepatic encephalopathy is a common complication of cirrhosis. Its development heralds a poor prognosis. Hepatic encephalopathy is often precipitated by an identifiable factor. Prompt diagnosis of precipitating factors is the key to management of this reversible complication of cirrhosis. To determine the frequency of precipitating factors for hepatic encephalopathy in patients diagnosed with cirrhosis. Descriptive Study. The study was carried out at Combined Military Hospital Lahore from 18.6.07 to 18.12.2007. Eighty Consecutive patients, 18 years and above of both genders suffering from hepatic encephalopathy were included in the study. Precipitating factors of hepatic encephalopathy were identified with the help of clinical examination and investigations. Majority of patients [63.8%] had one precipitating factor; more than one factor was found in 27.5%. Upper gastrointestinal bleed [56%] and infections [27%] [spontaneous bacterial peritonitis and urinary tract infections] were the leading precipitating factors. Use of diuretics/ electrolyte imbalance and constipation were found in 19% and 7% of patients respectively. No precipitating factor was detected in 9% of patients. In majority of patients with hepatic encephalopathy, precipitating factor/ factors could be easily identified

Chronic diarrhea; large gut causes

To determine the frequency of large bowel causes of chronic diarrhea in adult Pakistani patients. Cross sectional study. Medical unit 1 at Combined Military Hospital Lahore, Pakistan. Six months [from 01-11-2007 to 30-4-2008]. Fifty adult patients with chronic diarrhea, irrespective of their gender were selected by non probability convenient sampling. Patients already diagnosed with diseases known to cause diarrhea and those with toxic mega colon were excluded from the study. All patients were subjected to fiberoptic colonoscopy and findings were recorded. Biopsies were taken from suspected lesions or from normal looking mucosa. Diagnosis was made with colonoscopic and histopathologic findings. Thirty two [64%] patients had abnormal findings visible on colonoscopy. Histopathology was normal in 18 [36%]. Twenty [40%] patients had ulcerative colitis, seventeen [34%] had IBS, five [10%] had CA colon and three [6%] patients had crohn's disease. Other diagnoses included non specific colitis, tubulovillous adenoma and infection. Twenty three out of 24 patients [95%] who had blood in stools had a visible abnormality on colonoscopy whereas colonoscopy was positive in only 33% of patients who did not have blood in stools. Most causes of large gut chronic diarrhea can be identified by colonoscopy and biopsy. Colonoscopy has a very high yield in chronic diarrhea and should be recommended for its work up. Its yield is even higher in patients with bloody diarrhea