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