Imran Ahmad, Zulfiqar Ali Amin, Hafiz Muhammad Ashraf.
Determination of factors precipitating encephalopathy in patients with liver Cirrhosis.
Pak Armed Forces Med J Jan ;56(3):284-8.

Background: Hepatic encephalopathy is one of the potentially fatal complications seen in patients with advanced hepatic cirrhosis heralding a poor prognosis. Various clinical conditions have been implicated to precipitate encephalopathy with decompensated cirrhosis. Objective: To determine the frequency of various factors precipitating hepatic encephalopathy in our setup. Design: It is a single centre, descriptive study. Place and Duration of Study: In Combined Military Okara from January to December 2005. Patients and Methods: Forty three patients admitted in the calendar year 2005 with the diagnosis of chronic liver disease / cirrhosis that were found to be in different grades of encephalopathy were included in the study. A careful clinical and laboratory assessment of all the cases was made and the search for the presence of various already identified precipitating factors was carried out. Results: Fifty six percent of the patients included in the study were males and 41.9% were females. Mean age of patients was 56.46 years. Evidence of HCV infection was found in 83% and that of HBV in 17%. Upper gastrointestinal bleed was present in 37.2%, constipation in 20.9% and hypokalemia in 14% of the total patients. No cause was identifiable in 9.3% of the patients. Conclusion: Upper gastrointestinal bleed is the most common factor followed by constipation and electrolyte imbalance.

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