To Study Various Clinical Manifestations of Hepatic Encephalopathy and to Determine Correlation of Serum Ammonia Level & Severity of Hepatic Encephalopathy

Abstract

INTRODUCTION: Hepatic encephalopathy is a frequent complication and one of the most debilitating manifestation of liver disease as affecting the lives of patients and their families. It mainly affected patients exhibit alterations in psychomotor, intellectual, cognitive, emotional, behavioural and fine motor functions. Ammonia is one of the most important curprit for hepatic encephalopathy. Many studies have been done to prove that ammonia is one of the important causative agent in the severity and outcome of hepatic encephalopathy. However, there are no universally accepted standards for the definition, diagnosis, classification, or treatment of hepatic encephalopathy. AIM: To study various clinical manifestations of hepatic encephalopathy and to determine correlation of serum ammonia level & severity of hepatic encephalopathy. METHODS: This study was carried out in Dhiraj Hospital affiliated with SBKS MIRC after IEC approval, 50 patients of hepatic encephalopathy according to West Hevan criteria were enrolled after obtained informed consent. Detailed history and clinical examination done in all patients. Serum ammonia level was done of all the patient at the time of admission. RESULTS: 50 patients studied in the study group, the mean age is 41.80 ± 7.18 years. 78 % of the patients were having constipation and hematemesis as precipitating factors. Long duration of alcoholism having higher mean serum ammonia level (P value <0.001). The biochemical marker like liver function test and renal function test were severely deranged in higher serum ammonia level and was statistically significant (P value <0.001). Mean serum ammonia levels of clinical grade I, II, III, xi and IV are 101.71 ± 10.33, 104.1 ± 18.13, 115.36 ± 18.16, and 139.22 ±28.64 respectively. The association between mean ammonia level and clinical severity grading is statistically significant (P value <0.001). Difference in mean serum ammonia level among the different group of hepatic encephalopathy were also found to be statistically significant (P value <0.001). CONCLUSION: Hepatic encephalopathy is a disease which is based on clinical decision. In this study, we conclude that serum ammonia levels correlate strongly with clinical severity of hepatic encephalopathy. Serum ammonia can be useful as a diagnostic test as well as biochemical marker of severity of hepatic encephalopathy.