In this article, we will discuss the Clinical Features of Acute on Chronic Hepatic Encephalopathy (Acute Liver Failure). So, let’s get started.
The clinical features of acute on chronic or chronic hepatic encephalopathy are more or less same except the patients of chronic hepatic encephalopathy have stigmata of chronic liver disease, i.e. hepatitis or cirrhosis.
1. Feature of encephalopathy, e.g. day-night sleep reversal, drowsiness, confusion, asterixis, constructional apraxia dysarthria, tremors, delirium and coma.
2. Stigmata of cirrhosis of liver and liver cell failure: These include:
•Mild to moderate jaundice due to hepatic decompensation.
•Ascites, pitting oedema pleural effusion: They are due to combined effect of portal
hypertension and liver cell failure.
• Skin changes, e.g. palmar erythema,
spider angiomata, cyanosis (AV
shunting in the lungs). Pigmentation
and Dupuytren’s contractures, clubbing
of fingers, white nails, etc.
• Endocrinal changes, e.g. loss of axillary
and pubic hair, loss of libido.
• Men: Gynaecomastia, impotence, testicular atrophy.
• Women: Menstrual irregularity,
ammenorrhoea, breast atrophy.
• Haematological, e.g. anaemia, pancytopenia (hypersplenism), bruises, purpura, menorrhagia (coagulopathy due to Vitamin K deficient factors). Glossitis and cheilosis occur due to vitamin deficiency.
• Symptoms and sign of portal hypertension e.g. caput medusae (collaterals around the umbilicus), variceal bleed (haemetemesis), rectal varices, fetor hepaticus and splenomegaly.
• Alcoholic stigmatas: Loss of axillary and pubic hair, gynaecomastia, red nasal tip and ear lobule, parotid enlargement, muscle weakness and wasting may be present in alcoholic cirrhosis. These are called alcoholic stigmatas.
• Pyrexia: Fever may be a presenting
feature in up to 35% of patients and suggest alcoholic hepatitis, spontaneous bacterial peritonitis or intercurrent infection as the cause.
• Bone changes i.e. osteoporosis or osteopenia may be present due to chronic liver disease.