Diagnosis of Acute Hepatic Encephalopathy

In this article, we will discuss the Diagnosis of Acute Hepatic Encephalopathy. So, let’s get started.

Diagnosis

It is based on the clinical features supported by investigations.

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.
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