Precipitating Factors of Hepatic Encephalopathy in with Cirrhocis of Liver

OBJECTIVE: To determine the precipitating factors and outcome of Hepatic encephalopathy in patients of cirrhosis of liver. STUDY DESIGN: Prospective Descriptive study PLACE AND DURATION: The study was conducted in the department of Medicine Liaquat University of Medical and Health Sciences Jamshoro / Hyderabad from July 2009 to December 2009. PATIENTS AND METHOD: Ninety patients of cirrhosis of liver presented with hepatic encephalopathy were included in the study. Patients presented with hepatic encephalopathy due to fulminate hepatic failure, hyper and hyperglycemic coma, stroke and uremia were excluded from the study. Precipitating factors of encephalopathy were recognized on the basis of history, clinical examination and laboratory investigations. Statistical analysis was done using SPSS version 16.0 RESULTS: Out of 90 patients of hepatic encephalopathy Hypokalemia was found to be the commonest precipitating factor 34(37.8%), dehydration 22(24.4%), hyponatremia in 12 (13.3%), constipation in 28(31.1%), Hematemasis 9(10.0%), Infection in 27(27.8%). while in 12(13.3%) patients precipitating factor was not identified. 41(45.6%) patients were found in grade II encephalopathy with 61-70 years age group patients 30(33.3%) were more affected than younger age group. Whereas viral infection was the commonest etiological factor of cirrhosis of liver, anti HCV was found in 53(58.9%), hepatitis B 8(8.9%) while hepatitis B and HCV both positive in one patient (1.11%). CONCLUSION: In most of the patients the precipitating factors for hepatic encephalopathy were electrolyte imbalance, dehydration, constipation and infection because of over use of diuretic therapy, dietary restrictions, poverty and poor hygienic measures.