In this article, we will discuss the Diagnosis of Acute Hepatic Encephalopathy. So, let’s get started.
It is based on the clinical features supported by investigations.
- Complete haemogram may reveal anaemia (mostly macrocytic and leukocytosis).
- Serum bilirubin is slightly raised. Both conjugated and unconjugated fractions are increased. Serum bilirubin >20 mg% is a bad prognostic sign.
- Serum transaminases: They are raised initially in hepatitis, may fall progressively with progression of the disease, hence, fall off SGOT/SGPT in acute hepatic coma is not a healthy sign but constitutes a bad prognostic parameter. The paracetamol toxicity leads to much higher rise in enzymes (50-100 times). The serum amylase levels are elevated at least 3 times due to renal dysfunction.
- Virological studies: This includes estimation of IgM anti-HBc, IgM, anti-HAV, HEV, HCV, CMV, herpes simplex and EBV.
- Serology: Serum antibodies, ANA, anti-mitochondrial antibodies indicate autoimmune hepatitis
- Coagulation profile: Prothrombin time (PT) and PTT, INR are prolonged in severe form of the disease. PT >50/sec is also a bad prognostic sign in acute hepatic coma.
- EEG: It is done to grade the hepatic coma. A characteristic symmetric high voltage triphasic slow waves pattern (2-5/sec) on EEG seen in grade I to III while delta wave activity appears in grade IV coma.
- Serum ammonia levels are high and correlate with the development of encephalopathy and intracranial hypertension.
- Ultrasonography (USG) of the liver shows reduce liver size (usually <10 cm) with normal echotexture.
- Toxicology screen of blood and urine: Ceruloplasmin, serum and urinary copper may be done.
- Elevated serum troponin-1 levels due to subclinical myocardial injury.