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Best Paper Award :
Dr. Dhrubo Jyoti Sen
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Abstract

MAXIMIZING TREATMENT SUCCESS IN HEPATIC ENCEPHALOPATHY: A COMPREHENSIVE FRAMEWORK FOR ENHANCED OUTCOMES

*Dr. Neelam Dangi, Krishna Hingad, Aanchal Mogri, Drishti Chouhan

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Abstract

Hepatic encephalopathy (HE) is a neuropsychiatric disorder arising from portosystemic venous shunting, independent of inherent liver disease. This study aims to explore an effective management strategy for complications associated with liver cirrhosis. The literature review highlights the prevalence of HE, affecting up to 20% of decompensated cirrhosis cases and 50% of patients with transjugular intrahepatic portosystemic shunt (TIPS). The survival probability at one and three years is approximately 42% and 23%, respectively. The underlying causes of HE involve factors such as renal failure, gastrointestinal bleeding, infections, electrolyte imbalance, and medication non-compliance. HE is clinically categorized into three types, with Type C being the most common and often associated with cirrhosis. Pathophysiological mechanisms include inflammation, oxidative stress, impaired brain energy metabolism, neurotoxins, and blood-brain barrier permeability. Ammonia plays a central role, accumulating in the brain due to liver dysfunction and portosystemic shunting. Patients with cirrhosis often exhibit disturbances in intestinal flora, contributing to the pathophysiology of HE. Neurological and psychiatric manifestations vary from mild cognitive impairment to severe unconsciousness. Diagnosis relies on the West Haven criteria, assessing mental status and neuromotor function. Laboratory abnormalities include elevated bilirubin, liver enzymes, and ammonia levels. Various neuropsychiatric tests, such as the number connection test (NCT), Psychometric Hepatic Encephalopathy Score (PHES), inhibitory control test (ICT), and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), aid in diagnosis. Treatment options encompass nonabsorbable disaccharides, antibiotics (e.g., rifaximin), L-ornithine laspartate (LOLA), and zinc. Prophylactic measures, including avoiding central nervous system depressants and intubation for at-risk patients, are recommended. This study provides a comprehensive overview of HE, addressing its clinical manifestations, diagnostic modalities, and various treatment options. The proposed management strategy aims to improve patient outcomes by considering the multifactorial nature of this complex condition.

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