precipitants for hepatic encephalopathy

 Q: Which of the following is more of a risk for increased ammonia production, its absorption, or its entry into the brain to exacerbate hepatic encephalopathy? (select one) 

 A) Metabolic acidosis

 B) Metabolic alkalosis

Answer: B

The list of precipitants for hepatic encephalopathy is long including drugs, dehydration, portosystemic shunting, vascular occlusions, and primary hepatocellular carcinoma. 

Factors that increase ammonia production, or its absorption, or its entry into the brain includes excess dietary intake of protein, gastrointestinal bleeding, infection, electrolyte disturbances (most importantly hypokalemia), constipation, and metabolic alkalosis.

#hepatology

References:

1. Khungar V, Poordad F. Hepatic encephalopathy. Clin Liver Dis 2012; 16:301. 

2. Mumtaz K, Ahmed US, Abid S, et al. Precipitating factors and the outcome of hepatic encephalopathy in liver cirrhosis. J Coll Physicians Surg Pak 2010; 20:514. 

3. Onyekwere CA, Ogbera AO, Hameed L. Chronic liver disease and hepatic encephalopathy: clinical profile and outcomes. Niger J Clin Pract 2011; 14:181.