ENCEPHALOPATHY

ENCEPHALOPATHY
DISORDER OF CEREBRAL
FUNCTION ==> Inflammation (-)

DIGESTIVE TRACT
1. Hepatic Encephalopathy
2. Kernicterus
3. Reye Syndrome
4. Dehydration +disorder of consciousness
5. Hypo/hypernatremia
severe hypophosphatemia

GE + SEVERE DEHYDRATION
CIRCULATORY DISTURBANCES

OXYGENATION

CONSCIOUSNESS

GE+SEVERE DEHYDRATION+ENCEPHALOPATHY
COMA SHOCK

P
< 1 mg %
Energy

Dysfunction of
leucocytes &
thrombocytes

RBC
O2 delivery
Cerebral Anoxia

Rhabdomyolisis

KERNICTERUS
= BILIRUBIN ENCEPHALOPATHY

Unconsciousness
Spasme
Convulsion
Mortality 75%
Recovery - Blind
- Deafness
- Neuromusc. Incoord.
(chorea athetosis)

Th

1. EXCHANGE TRANSFUSION ==> UNCONJUG.

BILIRUBIN > 20 mg %
2. PHOTOTHERAPY
3. PHENOBARBITAL
4. INHIBITION OF ABSORPTION
5. TIN PROTOPORFIRIN
INHIBITION OF BILIVERDIN TO BILIRUBIN
6. SUPPORTIVE

HEPATIC ENCEPHALOPATHY
= LIVER FAILURE
= HEPATOCELLULER FAILURE
= HEPATOCYTIC FAILURE
= GAGAL HATI
HEPATIC COMA
PORTO SYSTEMIC ENCEPH

FULMINANT 2 WEEKS
SUBFULMINANT 2-8 WEEKS

CLINICAL GRADING OF HEPATIC ENCEPHALOPATHY

I.

CONFUSED

II.

DROWSY

III.

STUPOROUS

IV.

- COMA
- DEEP COMA

HEPATIC COMA

Systemic

t
a
p
He

.
V
ic

Inferior v. cava

liver

portal v.
t
gu

Porto systemic encephelopathy

LIVER FAILURE

ENCEPHALOPATHY
COAGULOPATHY
HALLMARK

DYSFUNCTION
INTRAHEPATIC
METABOLISM

THERAPY :
1. VENTILATION
2. WATER & ELECTROLYTES
3. COAGULOPATHY:
- Vitamin K
- Transfusion : Fresh Frozen Plasma
4. BLOOD AMMONIA (NH3) :
- lactulose
- neomycine Nephrotoxic
5. REDUCING INTRACRANIAL PRESSURE :
- cerebral edem : steroid, mannitol, etc.
- hypokarbia Cerebral Blood Flow
6. MONITORED CLOSELY FOR INFECTION
7. HEPATOTOXIC DRUGS WITHDRAWN :
- eg : Sedative

ENCEPHALOPATHY

REYE SYNDROME

FATTY DEGENERATION
BLOOD NH3

Mitochondrial dysfunction
HYPOGLYCEMIA
ACUTE

SALICYLIC ACID

Th

1. CONTROL OF INTRACRANIAL PRESSURE

2. WATER & ELECTROLYTES
3. ADEQUATE OXYGENATION
4. CONTROL OF HYPOGLICEMIA

5. COAGULOPATHY IS MANAGED
6. EXCHANGE TRANSFUSION

GASTROINTESTINAL
HEMORRHAGE

GI BLEEDING
GUT
OUT

- BLOOD DISORDERS :
LEUKEMIA

IN

BLOOD PER OS

- SYSTEMIC
- RUPTURE OF THE
AORTA

HEMATEMESIS

BLOOD PER
ANUM

HEMATEMESIS
DIGESTIVE
TRACT

INGESTION

INFANTS
-NIPPLES
-HEMORRHAGIC DISEASE

CHILDREN
EPISTAXIS

OF THE NEWBORN
-INGESTION OFMATERNAL BLOOD
(MATERNAL SWALLOWED BLOOD
SYNDR.)

APT DOWNEY TEST

- MUCOSAL LESION
- VARICEAL BLEEDING

NEW BORN

Hb F

50-90 %

ALKALI RESISTENT

Hb A

Hb A2

HEMATEMESIS
MUCOSAL LESION PORTAL HYPERTENSION

PEPTIC
ULCER

ESOPHAGEAL
VARICES
GASTRITIS

DRUGS
- SALICYLIC ACID

PEPTIC ULCER
PROLONGED
EXCESS ACID

BREAKDOWN IN
BARRIER

INFECTION

H. PYLORI

ACETYLCHOLINE

PROSTAGLANDIN

ZOLLINGER ELLISON
SYNDR. NON B ISLET
CELL

HISTAMIN
GASTRIN

MUSCARINIC
RECEPTOR

H2 RECEPTOR
(-)
ADENYLCYCLASE
c AMP

PROTEINKINASE

Na K ATP ase

HCL

GASTRIN
RECEPTOR

TH/
1. MUCOSAL PROTECTION

SUCRALFATE
2. ACID SECRETION
3. NEUTRALIZED ACID

ANTACIDE

4. ERADICATION OF H. PYLORI
- METRONIDAZOLE
- CLARITHROMYCIN
- OMEPRAZOLE

2 WEEKS

ACID SECRETION
1. H2 RECEPTOR BLOCKER : CIMETIDINE
RANITIDINE
2. PROTON PUMP INHIBITOR :
OMEPRASOLE
3. PROSTAGLANDIN SYNTHETASE:
MISOPROSTOL
4. ANTICHOLINERGIC : PIRENZEPINE

INFECTION OF H. PYLORI
1. INVASIVE

TISSUE

MICROSCOPIC
CULTURE
UREA TEST

2. NONINVASIVE
-UREA BREATH TEST
-SEROLOGY : IgG

BLEEDING PER ANUM

OCCULT

HEMOCCULT TEST

OVERT

MELENA

HEMATOCHEZIA

Materials

Heme protein

Hydrogen peroxidase

Colorless guaiac

Blue quinone
25

HEMATOCHEZIA

WITH
DIARRHOEA

WITHOUT
DIARRHOEA

DYSENTERY

- ANAL FISSURE

SYNDROME

- RECTAL POLYP

WITHOUT
STOOLS

INVAGINATION

DYSENTERY SINDROME = BLOODY DIARRHOEA

1. DYSENTERY
- BACILLARY
- AMOEBIC
2. Enterocolitis
- Cows milk allergy
3. Trichuriasis
4. Others

- Entero invasive E coli

- C. jejuni