Bughdad Khan, Zahidullah Khan, Jamalud Din, Hamza Khan, Muhammad Taimur Khan.
Spectrum of factors precipitating hepatic enchephalopathy in patients with liver cirrhosis.
J Med Sci Jan ;19(2):62-5.

Objective: To determine the factors precipitating hepatic encephalopathy (HE) in patients with liver cirrhosis in a tertiary care hospital in Peshawar. Material and Methods: This hospital based descriptive, cross sectional study was conducted in Department of Medicine, Khyber Teaching Hospital, Peshawar from December 2009 to July 2010. A total of 100 admitted patients with clinical evidence of hepatic encephalopathy were studied. A detailed history was taken either from patient or his/her close relative and clinical examination was performed with special consideration of the gastrointestinal system. Symptoms of hepatic encephalopathy were graded according to West Haven classification system. Relevant investigations were done where needed. Results: The study included 100 patients, males were 60 (60%) and females were 40 (40%). Majority of the patients (65%) were in age range of 35-50 with mean age 46 years. Constipation was the leading factor precipitating hepatic encephalopathy in 33% of patients, infections in 21%, gastrointestinal bleed (GI bleed) in 20%, electrolyte imbalance in 7%, high protein intake in 5%, sedatives in 2% while no cause could be identified in 5% of patients. Majority (46%) of the patients were in grade II hepatic encephalopathy. Sixty three percent of patients had class III Child-Pugh scoring. Mortality rate was 15%. Conclusion: In majority of patients with hepatic encephalopathy, precipitating factors can be identified and must be prevented.

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