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| Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a [[coma]]. Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms. | | Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a [[coma]]. Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms. |
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| ==Psychometric testing==
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| The number connection test (trail making test or Reitan Test) can help<ref name="pmid9566834">{{cite journal| author=Weissenborn K, Rückert N, Hecker H, Manns MP| title=The number connection tests A and B: interindividual variability and use for the assessment of early hepatic encephalopathy. | journal=J Hepatol | year= 1998 | volume= 28 | issue= 4 | pages= 646-53 | pmid=9566834 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9566834 }} </ref><ref name="pmid10347105">{{cite journal| author=Amodio P, Del Piccolo F, Marchetti P, Angeli P, Iemmolo R, Caregaro L et al.| title=Clinical features and survivial of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. | journal=Hepatology | year= 1999 | volume= 29 | issue= 6 | pages= 1662-7 | pmid=10347105 | doi=10.1002/hep.510290619 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10347105 }} </ref><ref name="pmid868833">{{cite journal| author=Conn HO| title=Trailmaking and number-connection tests in the assessment of mental state in portal systemic encephalopathy. | journal=Am J Dig Dis | year= 1977 | volume= 22 | issue= 6 | pages= 541-50 | pmid=868833 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=868833 }} </ref>.
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| The Psychometric Hepatic Encephalopathy Score (PHES) may help<ref name="pmid25400460">{{cite journal| author=Montagnese S, Balistreri E, Schiff S, De Rui M, Angeli P, Zanus G et al.| title=Covert hepatic encephalopathy: agreement and predictive validity of different indices. | journal=World J Gastroenterol | year= 2014 | volume= 20 | issue= 42 | pages= 15756-62 | pmid=25400460 | doi=10.3748/wjg.v20.i42.15756 | pmc=4229541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25400460 }} </ref><ref name="pmid11434627">{{cite journal| author=Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H| title=Neuropsychological characterization of hepatic encephalopathy. | journal=J Hepatol | year= 2001 | volume= 34 | issue= 5 | pages= 768-73 | pmid=11434627 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11434627 }} </ref><ref name="pmid21440091">{{cite journal| author=Riggio O, Ridola L, Pasquale C, Pentassuglio I, Nardelli S, Moscucci F et al.| title=A simplified psychometric evaluation for the diagnosis of minimal hepatic encephalopathy. | journal=Clin Gastroenterol Hepatol | year= 2011 | volume= 9 | issue= 7 | pages= 613-6.e1 | pmid=21440091 | doi=10.1016/j.cgh.2011.03.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21440091 }} </ref> including a simplified version (SPHES)<ref name="pmid21440091"/>. The SPHES drops the trail making tests and so includes:
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| * Digit symbol test (DST)
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| * Serial dotting test (SDT)
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| * Line tracing test (LTT)
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| The [[Mini-Mental State Examination]] has been tested and may<ref name="pmid25755545">{{cite journal| author=Corrias M, Turco M, Rui MD, Gatta A, Angeli P, Merkel C et al.| title=Covert hepatic encephalopathy: does the mini-mental state examination help? | journal=J Clin Exp Hepatol | year= 2014 | volume= 4 | issue= 2 | pages= 89-93 | pmid=25755545 | doi=10.1016/j.jceh.2013.12.005 | pmc=4116703 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25755545 }} </ref><ref name="pmid23625323">{{cite journal| author=Torres DS, Abrantes J, Brandão-Mello CE| title=Cognitive assessment of patients with minimal hepatic encephalopathy in Brazil. | journal=Metab Brain Dis | year= 2013 | volume= 28 | issue= 3 | pages= 473-83 | pmid=23625323 | doi=10.1007/s11011-013-9405-3 | pmc=3734603 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23625323 }} </ref> or may not<ref name="pmid23815160">{{cite journal| author=Koziarska D, Wunsch E, Milkiewicz M, Wójcicki M, Nowacki P, Milkiewicz P| title=Mini-Mental State Examination in patients with hepatic encephalopathy and liver cirrhosis: a prospective, quantified electroencephalography study. | journal=BMC Gastroenterol | year= 2013 | volume= 13 | issue= | pages= 107 | pmid=23815160 | doi=10.1186/1471-230X-13-107 | pmc=3716589 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23815160 }} </ref> help diagnose encephalopathy.
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| ==References== | | ==References== |
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Overview
One of the earliest manifestations of hepatic encephalopathy is "day-night reversal". In other words, affected individuals tend to sleep during the day and stay awake at night. Another early manifestation is impairment in spatial perception. This can be made apparent by noting the patient's poor ability to copy or draw various simple images, e.g cube, star, clock. This deficit can also be demonstrated by administering a test which has the patient connect a number of randomly placed dots on a sheet of paper (the "trail test" or "numbers connecting test").
History and Symptoms
Symptoms many begin slowly and gradually worsen, or they may begin suddenly and be severe from the start.
Symptoms may be mild at first. Family members or caregivers may notice that the patient has:
- Breath with a musty or sweet odor
- Change in sleep patterns
- Changes in thinking
- Confusion that is mild
- Forgetfulness
- Mental fogginess
- Personality or mood changes
- Poor concentration
- Poor judgment
- Worsening of handwriting or loss of other small hand movements
More severe symptoms may include:
- Abnormal movements or shaking of hands or arms
- Agitation, excitement, or seizures (occur rarely)
- Disorientation
- Drowsiness or confusion
- Inappropriate behavior or severe personality changes
- Slurred speech
- Slowed or sluggish movement
Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma. Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms.
References
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