Search In this Thesis
   Search In this Thesis  
العنوان
Clinical Audit on Management of Hepatic Encephalopathy in Children admitted at Gastroenterology & Hepatology Unit of
Assiut University Children Hospital/
المؤلف
Maken, Johnny Milad.
هيئة الاعداد
باحث / جونى ميلاد مكين
مشرف / فاطمة عبدالفتاح على
مناقش / احمد جاد الرب عسكر
مناقش / حسنى محمد احمد
الموضوع
pediatrics.
تاريخ النشر
2017.
عدد الصفحات
115 p. ;
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
طب الأطفال ، الفترة المحيطة بالولادة وصحة الطفل
الناشر
تاريخ الإجازة
10/7/2018
مكان الإجازة
جامعة أسيوط - كلية الطب - Faculty of medicine Pediatric
الفهرس
Only 14 pages are availabe for public view

from 137

from 137

Abstract

Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, after exclusion of brain disease (Butterworth, 2016). It is characterized by personality changes, intellectual impairment, and a depressed level of consciousness (Shawcross et al., 2016). Hepatic encephalopathy is an important metabolic disturbance in children (Suchy, 2004).
Hepatic encephalopathy is best diagnosed by excluding other possible causes of encephalopathy alongside identifying the precipitating cause, and confirming the diagnosis by a positive response to empiric treatment. Empiric therapy for HE is largely based on the principle of reducing the production and absorption of ammonia in the gut through administration of pharmacological agents such as rifaximin and lactulose, which are approved by the FDA for the treatment of HE (Prakash & Mullen, 2010).
The prevention of episodes of hepatic encephalopathy is an important goal in the treatment of patients with liver disease (Poordad, 2007).
Controlling precipitating factors in the management of HE is of paramount importance, because nearly 90% of patients can be treated with just correction of the precipitating factor (Strauss et al., 2002).
The most important component of managing a child with hepatic encephalopathy is basic intensive care with regulation of fluid status, glucose and electrolyte homeostasis. Specific management includes measures to reduce serum ammonia concentrations, and the prevention and prompt treatment of complications. Methods to reduce ammonia target various steps in its metabolism. This includes reducing its production and absorption from the intestine and promoting its metabolism in the liver (Arya et al, 2010).
-100-
Chapter (8) English Summary
This study aimed to assess to how much the adapted protocols of management of hepatic encephalopathy were applied at Gastroenterology & Hepatology Unit of Assiut University Children Hospital.
The present study included 52 children with hepatic encephalopathy who admitted to Gastroenterology & Hepatology Unit of Assiut University Children Hospital over one year period from the 1st of March 2016 to the 28th of February 2017. Their age range from 4 months to 15 years. 69.2% of cases were males and 30.8% were females.
In the present study; demographic data were recorded in 100% of cases. Detailed history intake was recorded in most cases except history of drug intake which was not recorded in 23.15% of cases, history of reversal of sleep rhythm which was not recorded in 17.3% of cases and history of behavioral changes which was not recorded in 9.6% of cases. Data of examination were recorded in most cases except fetor hepaticus, asterixis and neurological examination which were not recorded in all cases. Basic and mandatory investigations in diagnosis of hepatic encephalopathy were done. The international guidelines for the management of hepatic encephalopathy have been followed by the Gastroenterology and Hepatology Unit of Assiut University Children Hospital in most treatment lines except admission to the intensive care unit and prophylactic endotracheal intubation in comatosed patients. Also oral branched chain amino acids and rifaximin were not given. L-carnitine and zinc were not given to all patients. It is recommended to take detailed history including history of drug intake in all cases. Full neurological examination must be done in all cases. Admission at intensive care unit and prophylactic endotracheal intubation are mandatory in severe HE. Recommending use of oral BCAA, zinc and L-carnitine and using rifaximine in recurrent HE.