The diagnosis of hepatic encephalopathy

Hepatic encephalopathy, also known as hepatic coma, Cirrhosis of the liver failure caused the most common and one of the most serious complications. Neural mental disorder for its main features, mainly due to portal vein bypass the liver caused by the inflow of circulation, mechanisms of the pathogenesis of ammonia poisoning theory, ammonia mercaptan short chain fatty acids and synergistic toxicity of doctrine, after the delivery of false doctrine and amino acid metabolic imbalance theory.
[Diagnosis]
1. History: cirrhosis, liver, portosystemic shunt primary diseases, such as history, and upper gastrointestinal bleeding. Caving ascites, a large number diuretic, high-protein diet, sleeping pills, infection incentives.
2. Clinical manifestations: prodromal phase (Phase I) to mild emotional, the main character change, such as excited, excited, and so on. Early coma (II) to consciousness disorder and behavioral disorders dominated, such as disorientation, lethargy and exciting turn, increased muscle tension, such as pathological positive reflection, there Flapping-Wing-like tremor, the most characteristic. Drowsiness phase (Phase III), drowsiness and serious thought disorder mainly, it is not capable of Peter, but not normal answer, ataxia. Coma stage (stage IV), is shallow deep coma gradually into a coma, completely lost consciousness, various reflex disappeared, dilated pupils.
3. Laboratory tests: blood ammonia increased plasma amino acid imbalance, branched-chain amino acids reduced, aromatic amino acids increased, the ratio of the two ≤ 1 (normal> 3), liver function tests, often chronic liver dysfunction performance.
4. EEG examination: bilateral symmetry in his forehead and the top of the high-slow wave.