apsul
Table 1. A Grading System for Hepatic Encephalopathy.*
Grade
Level Of
Consciousness
Personality and Intellect
Neurologic Sign
Electroencephalographic
Abnormalites
0 Normal
Normal
None
None
Subclinical Normal
Normal
Abnormalities only on
psychometric analysis
None
1
Inverted sleep
pattern,restlessness
Forgetfulness,mild
confusion,agitation,irritability
Tremor,apraxia,incoor-
dination,impaired hand
writing
Triphasic waves ( 5 cycles/sec)
2
Lethargy,slow
responses
Disorientation as regards
time,amnesia,decreased
inhibitions, inappropriate
behavior
Asterixis,dysarthria,ataxia
hypoactive reflexes
Triphasic waves ( 5 cycles/sec)
3
Somnolence but
rousability, confusion
Disorientation as regards
place,aggressive behavior
Asterixis,hyperactive
reflexes,Babinski
signs,muscle rigidity
Triphasic waves ( 5 cycles/sec)
4 Coma
None
Decerebration
Delta
activity
* The system is based on clinical and electroencephalographic features suggested by Gitlin.
Table 2. Differential Diagnosis of Hepatic Encephalopathy.*
Disorder Diagnostic
Test
Metabolic encephalopathies
Hypoglycemia
Electrolyte imbalance
Hypoxia
Carbon doxide narcosis
Azotemia
Ketoacidosis
Blood chemical analysis
Toxic encephalopathies
Alcohol
Acute intoxication
Withdrawal syndrome
Wernicke-Korsakoff syndrome
Psychoactive drugs
Salicylates
Heavy metals
Measurement of blood alcohol level, erythrocyte transketolase
activity,therapeutic response to thiamine, toxicologic screening
Intracranial lesions
Subarachnoid,subdural,or intracerebral hemorrhage
Cerebral infarction
Cerebral tumor
Cerebral abscess
Meningitis
Encephalitis
Epilepsy or postseizure encephalopathy
Computed tomorgraphy,lumbar puncture,arteriography, electroen
cephalography,virologic testing
Neuropsychiatric disorders
Tests for organic brain syndromes
* Data are adapted from Ferend
This diagnosis is especially pertinent to patients with liver disease
Dikutip dari : Riordan SM,,Williams R..Treatment of Hepatic Encephalopathy. N.Engl.J.Med 1997;337:473-9
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