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conferenceseries
.com
Volume 8
Journal of Gastrointestinal & Digestive System
Gastroenterology Congress 2018
August 06-07, 2018
August 06-07, 2018 Osaka, Japan
14
th
Annual Congress on
Gastroenterology & Hepatology
Ammonia level may not be associated with the severity of hepatic encephalopathy: An extensive literature
review
Eyad M O E Gadour
University Hospital of South Manchester NHS Foundation Trust, UK
T
his literature provides a review regarding the value of checking ammonia level in hepatic Encephalopathy. The research
examines the prognosis of Ammonia level in the blood, diagnosis and management of hepatic encephalopathy. The major
clinical characteristics of diagnosis of hepatic encephalopathy are depressed consciousness level, intellectual impairment
and personality changes. During diagnosis, it is essential to detect signs suggesting hepatic encephalopathy among the
patients suffering from liver disease and there is no clear indication of other causes to brain dysfunction. Thus, realization
of precipitating factors indicated above supports hepatic encephalopathy diagnosis. The prognosis depends on the grade of
liver failure, time of delivering effective treatment particularly precipitating factors and comorbidity. The progress of hepatic
encephalopathy among patients with cirrhosis is correlated with a worse prediction and might cause frequent and elevated
relapses. The patients with obvious hepatic encephalopathy in the hospitals have a 3.9 risk of increasedmortality. Approximately
70% of having cirrhosis exhibit restrained symptoms of hepatic encephalopathy. These symptoms are likely to weaken patients.
Obvious hepatic encephalopathy manifests in patients suffering from cirrhosis, and the approximate infection rate is 30 to
45%. About 25 to 53% port systemic shunt surgery patients exhibit the condition. The suitable management practices entail
early diagnoses, aggressive identification of the precipitating factors and efforts to reduce severity. Evasion of some sedative
drugs has been proposed as a key management practice. The main approaches suggested in include: (1) Checking the level
of arterial ammonia during first evaluations in patients hospitalized due to impaired mental function and or cirrhosis. In
stable outpatients, ammonia levels are low. (2) Correcting hepatic encephalopathy precipitants including constipation,
gastrointestinal bleeding, metabolic disturbances and hypovolemia. (3) Providing prophylactic endotracheal intubation to
patients with grade 3 or grade 4 (severe encephalopathy) and have aspiration risks in the Intensive Care Unit (ICU). Lactulose
and Rifaximin use is useful but no superiority and can both be used if needed. Administration of low-protein diets in cirrhosis
patients resulted in deteriorating of established protein-energy malnutrition. Thus, protein restriction is likely to help some
patients with immediate effect after episodic hepatic encephalopathy. Certainly, malnutrition is regarded as a serious clinical
problem compared to hepatic encephalopathy among the patients. Blood ammonia mainly comes about due to the breakdown
of the unabsorbed dietary protein by bacteria in the intestines. Among the hepatic encephalopathy, the levels of ammonia in
the brain are higher compared to blood levels. High levels of ammonia in the blood may occur because of gastrointestinal
bleeding, acute liver failure and chronic liver disease. The major reasons for testing ammonia levels in hepatic encephalopathy
for patient who is presenting for the first time include: Checking for success of treatment options, checking for liver condition
following severe symptoms like excessive sleepiness and confusion, identifying disorders likely to cause brain damage, help in
predicting outcomes from diagnoses carried out prognosis of hepatic encephalopathy, however, for patients who are known
to have hepatic encephalopathy, in terms of recurrent admissions or previous diagnosis, checking ammonia is not routinely
recommended and carrying out the psychometric tests may be more useful.
Biography
Eyad M O E Gadour has an MRCP in Gastroenterology Spr from University Hospital of South Manchester NHS Foundation Trust in UK. He is currently working in
University Hospital of South Manchester NHS Foundation Trust, UK.
eyadgadour@doctors.org.ukEyad M O E Gadour, J Gastrointest Dig Syst 2018, Volume 8
DOI: 10.4172/2161-069X-C4-073