肝性脑病英文PPT.ppt

Hepatic Encephalopathy（HE）Dong Xuan第一页，共二十页。PartsDefinitionCausesHypothesisSymptoms and SignsExaminationsTreatment第二页，共二十页。severe liver diseases.metabolic disordercentral nervous system disorder main clinical symptoms disturbance of consciousnessbehavior disordercoma points第三页，共二十页。DefinitionHE is a complex,potentially reversible disturbance in central nervous system that occurs as a consequence of severe liver diseases.第四页，共二十页。CausesMainCirrhosis Severe hepatitis Fulminant liver failure Severe biliary infection Acute fatty liver of pregnancy period 70%caused by cirrhosis 第五页，共二十页。Precipitating factors of HE1)Gastrointestinal Bleeding2)Abuse of sedatives and narcotic3)Massive paracentesis and excessive diuresis4)InfectionsHypovolemia,shock,hypoxiaProtein breakdownAmmonia production benzodiazepines and barbituratesFluid or electrolyte abnormalities and acid base disturbancetissue breakdown第六页，共二十页。Several main hypothesesAmmonia IntoxicationFalse NeurotransmittersAmino Acid imbalanceThe Gamma-Amino butyric Acid hypothesis第七页，共二十页。Symptoms1.(prodromal stage)Slightly altered mood or behaviors2.(precoma stage)Somnipathy and inappropriate behaviors3.(lethargic stage)Drowsy and psychopath4.(coma stage)Deep comacentral nervous systemFour stages of hepatic encephalopathy 第八页，共二十页。第九页，共二十页。Flapping tremorA.Patient B.Doctor and patient第十页，共二十页。Classification Level Mental Status Flapping tremor Slightly Weak positive Somnipathy and Positive inappropriate Drowsy and Positive psychopath Deep coma Negative 第十一页，共二十页。Examinations1)Blood ammonia chronic()acute ()2)EEG slow small value3)Psychometric test Advantages :simple,no equipment Disadvantage:influenced by age and education第十二页，共二十页。Number connection test 第十三页，共二十页。Graphics connection test第十四页，共二十页。Imaging examination(CT or MRI)Acute HE :Cerebral edema Chronic HE:Encephalatrophy 第十五页，共二十页。Critical fricker-fusion frequencyThrough testing the retinal glial cell lesion to judge the brain astrocytes have swellingAdvantages:sensitive,simple and reliable 第十六页，共二十页。TreatmentPrinciples1）Eliminating or correcting precipitating factors2）Reducing plasma ammonia and other toxin3）Correcting plasma amino acid imbalance and supplying normal neurotransmitters第十七页，共二十页。4)Improving hepatocyte functions5)Liver transplantation第十八页，共二十页。Thank you第十九页，共二十页。内容(nirng)总结Hepatic Encephalopathy（HE）。1)Gastrointestinal Bleeding。Hypovolemia,shock,hypoxia。The Gamma-Amino butyric。Critical fricker-fusion frequency。5)Liver transplantation。you第二十页，共二十页。