Early identification of hepatic encephalopathy improves outcomes

2020 ◽  
Vol 29 (Sup17) ◽  
pp. S10-S13
Author(s):  
Richard Parker
Keyword(s):  
Hepatic Encephalopathy ◽  
Early Identification ◽  
Signs And Symptoms ◽  
Prompt Treatment ◽  
Overt Form

Early identification and prompt treatment of hepatic encephalopathy can help reduce its progression into its overt form. As the initial signs and symptoms of this complication can be extremely subtle, diagnosis can be difficult, particularly for non-specialists. This article describes how the use of simple and widely available tests can help facilitate this

Recognition and management of neonatal sepsis

2021 ◽  
Vol 30 (7) ◽  
pp. 410-415
Author(s):  
Luke William Crocker ◽  
Ayesha White ◽  
Paul Anthony Heaton ◽  
Débora Pascoal Horta ◽  
Siba Prosad Paul
Keyword(s):  
Neonatal Sepsis ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Evidence Based ◽  
Suspected Sepsis ◽  
Serious Illness ◽  
Prompt Treatment ◽  
Serious Infection ◽  
Common Causes ◽  
Red Flag

Neonatal sepsis results from acute bacterial or viral infection occurring in the first 28 days of life. It causes significant morbidity and mortality, although the outcome can be improved by early recognition and prompt treatment by health professionals. This article describes the most common causes of sepsis, and explains why neonates are particularly vulnerable to infection. It highlights the non-specific way in which an infant with a serious infection may present, indicating the crucial features to elicit during history taking and examination, and emphasising the ‘red-flag’ signs and symptoms that should increase suspicion of a serious illness. The authors have adapted National Institute for Health and Care Excellence guidelines to produce an evidence-based approach to the management of an infant with suspected sepsis, and describe the roles of nurses in ensuring effective treatment and best outcomes for these babies.

Cerebral vasospasm: early detection and intervention

1994 ◽  
Vol 14 (4) ◽  
pp. 33-37
Author(s):  
SL Armstrong
Keyword(s):  
At Risk ◽  
Cerebral Ischemia ◽  
Early Detection ◽  
Cerebral Vasospasm ◽  
Nursing Care ◽  
Signs And Symptoms ◽  
Ischemic Damage ◽  
Critical Problem ◽  
Prompt Treatment ◽  
Damage Recognition

Many patients survive SAH with minimal neurologic deficits but are at risk for developing further neurologic insult from ischemia resulting from cerebral vasospasm. Nursing care of the patient experiencing vasospasm is challenging. The nurse who is knowledgeable about the signs and symptoms of cerebral ischemia and necessity for continually reviewing the patient's neurologic status can initiate prompt treatment to prevent further ischemic damage. Recognition of this critical problem is the first step toward combating its ominous effects.

scholarly journals Hepatic Encephalopathy in Liver Cirrhosis: Precipitating factor and Outcome

2019 ◽  
Vol 17 (1) ◽  
pp. 2-4
Author(s):  
Dipendra Khadka ◽  
Dipendra Khadka ◽  
Anil Shrestha ◽  
S. D. Bassi ◽  
Binus Bhandari
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Hospital Stay ◽  
Early Recognition ◽  
Wide Spectrum ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Precipitating Factors ◽  
Cross Sectional ◽  
Precipitating Factor

Introduction: Hepatic encephalopathy, one of the major decompensating events of liver cirrhosis manifest as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma. The main aim of this study was to determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Methods: A hospital based cross-sectional study carried out in the Department of Medicine, Nepalgunj Medical College, Kohalpur from September 2018 to May 2019. Patients of liver cirrhosis with signs and symptoms of hepatic encephalopathy (HE) were enrolled in the study. Detailed history was taken with patients or patient's visitor regarding precipitating factors. Child Turcotte Pugh (CTP) class was used for assessing liver disease severity and West Haven classification was used for grading of hepatic encephalopathy. Results: Total patients of hepatic encephalopathy studied were 150. Among which, 114 (76%) were male and 36 (24%) were female. Mean age was 45 ± 11years. Common precipitating factors for hepatic encephalopathy identified were constipation 25.3%, Upper gastrointestinal bleed (9.3%), Spontaneous bacterial peritonitis (8%). No identifiable factor was observed in 6.7% cases. Significant relationship was noted with CTP class and grading of Hepatic encephalopathy. Hospital stay was also found longer (≥5 days) among patients having more than one precipitating factor. Conclusions: Early recognition of precipitants and patient education is very crucial in the management of hepatic encephalopathy. Patients having ≥ 2 precipitating factor had longer hospital stay and higher grade of hepatic encephalopathy.

scholarly journals Subacute liver failure of unknown origin

2018 ◽  
Vol 146 (3-4) ◽  
pp. 200-202
Author(s):  
Dragan Delic ◽  
Nikola Mitrovic ◽  
Aleksandar Urosevic ◽  
Jasmina Simonovic ◽  
Ksenija Bojovic
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Unknown Origin ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Decompensated Liver Cirrhosis ◽  
Synthetic Function ◽  
Severe Liver Dysfunction

Introduction. Acute liver failure is rare and very complex clinical syndrome, the consequences of the sudden and severe liver dysfunction. There are several causes of this condition (viruses, medications, toxins, metabolic, autoimmune and malignant diseases), but etiological agent often remains undiscovered. Case Outline. A 40-year-old male patient got ill suddenly with signs and symptoms relevant for acute hepatitis, which was confirmed with biochemical analysis. The cause of acute liver failure was not determined. Despite all therapeutic measures, clinical course of the disease was bad: severe icterus, decreased synthetic function of the liver and hepatic encephalopathy developed. In the later, subacute course of the disease, developed ascites, episodes of hepatic encephalopathy and biochemical findings of chronic hepatocellular failure. After three months treatment, in hepatic coma, there was lethal outcome. Histopathological findings confirmed the diagnosis of decompensated liver cirrhosis of unknown origin. Conclusion. The cause of acute liver failure often remains unclear; potential causes should be looked for in infections with unknown viruses or in toxins exposure. The disease is most commonly presented as subacute failure with the development of liver cirrhosis. Survival rate is low.

scholarly journals Nature Reviews Endocrinology: Acromegaly

2018 ◽  
Vol 2 (2) ◽  
pp. 01-02
Author(s):  
Chike Obi ◽  
Claudio Achebe
Keyword(s):  
Growth Hormone ◽  
Health Care Professionals ◽  
Early Identification ◽  
Treatment Initiation ◽  
Pituitary Surgery ◽  
Primary Treatment ◽  
Disease Awareness ◽  
Prompt Treatment ◽  
Insidious Onset ◽  
Surgical Cure

Acromegaly is a rare disease most often caused by the prolonged secretion of excess growth hormone from a pituitary adenoma. The disease is associated with multiple significant comorbidities and increased mortality. The delay to diagnosis is often long. This may be because of low disease awareness among health care professionals, the insidious onset of differentiating features, and because patients are likely to present with complaints typical of other conditions more frequently seen in primary care. Early identification of acromegaly facilitates prompt treatment initiation and may minimize the permanent effects of excess growth hormone. The primary treatment for many patients will be pituitary surgery, although not all patients will be eligible for surgery or achieve a surgical cure

scholarly journals Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Francesca Romana Ponziani ◽  
Barbara Funaro ◽  
Andrea Lupascu ◽  
Maria Elena Ainora ◽  
Matteo Garcovich ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Doppler Ultrasound ◽  
Transcranial Doppler ◽  
Early Identification ◽  
Transcranial Doppler Ultrasound ◽  
Minimal Hepatic Encephalopathy ◽  
Diagnostic Tools ◽  
Cirrhotic Patients ◽  
Cerebral Vascular

Abstract Minimal hepatic encephalopathy (MHE) is a subclinical complication of liver cirrhosis with a relevant social impact. Thus, there is urgent need to implement easy to use diagnostic tools for the early identification of affected patients. The aim of this study was to investigate cerebral blood flow, systemic hemodynamics as well as endothelial function of cirrhotic patients with MHE, and to verify their change after treatment with rifaximin. Fifty cirrhotic patients with or without MHE and an equal number of healthy controls underwent transcranial Doppler ultrasound (TCD), abdominal Doppler ultrasound (US), and measurement of flow mediated dilation (FMD). In cirrhotic patients diagnosed with MHE receiving rifaximin, the tests were repeated at the end of treatment. Middle (MCA) and posterior (PCA) cerebral artery resistive (RI) and pulsatility (PI) indices were higher in cirrhotic patients than controls, as well as renal and splenic artery RI. Conversely, FMD was reduced. MCA-RI and PI were even higher in cirrhotic patients with MHE compared to those without; a MCA-RI cut-off of 0.65 showed an accuracy of 74% in discriminating the presence of MHE, with 65% sensitivity and 76% specificity. Rifaximin treatment showed no efficacy in the modulation of cerebral vascular flow. In conclusion, cirrhotic patients with MHE have significantly increased cerebral vascular resistances that are not improved by rifaximin treatment. MCA-RI measurement has a good accuracy for the diagnosis of MHE and can be useful for the early identification of this harmful complication of liver cirrhosis.

scholarly journals Early identification using the referral system prolonged the time to onset for hepatic encephalopathy after diagnosing severe acute liver injury

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Keisuke Kakisaka ◽  
Yuji Suzuki ◽  
Hiroaki Abe ◽  
Takuya Watanabe ◽  
Kenji Yusa ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hepatic Encephalopathy ◽  
Liver Injury ◽  
Early Identification ◽  
Total Bilirubin ◽  
Acute Liver Injury ◽  
Referral System ◽  
Significant Difference ◽  
Risk Of Progression ◽  
Time To Onset

Abstract In 2004, we implemented a referral system for patients with acute liver injury (ALI) based on an established formula that estimates the risk of progression to acute live failure (ALF); however, the benefits of the system for patients with severe acute liver injury (SLI) remain unclear. We have evaluated the clinical significance of the referral system for SLI patients. Patients with ALI/SLI who were consecutively and prospectively listed on the system between 2004 and 2018 were analyzed. Of the 371 ALI/SLI/ALF patients on the system, 124 satisfied the criteria for SLI; 34 of these 124 progressed to SLI after registration. Multivariate analysis using age, sex, AST, ALT, creatinine, total bilirubin, prothrombin, presence of hepatic encephalopathy (HE), and SLI at registration revealed that HE was associated with high mortality. Among the 23 patients who developed HE, five who progressed to SLI after registration showed an increased time to HE development compared with patients who had SLI at the time of registration. However, there was no significant difference in survival time after HE development. We concluded that early identification of SLI patients using the referral system increased the time from SLI diagnosis to HE development.

Early identification and treatment of sepsis is vital

2019 ◽  
Vol 14 (5) ◽  
pp. 218-219
Author(s):  
Dorothy Lepkowska
Keyword(s):  
Health Professionals ◽  
Early Identification ◽  
General Public ◽  
Signs And Symptoms

There have been recent calls for all health professionals, as well as the general public to be educated on the signs and symptoms of sepsis. Dorothy Lepkowska discusses some of these

Assessment of sepsis in the critically ill

2016 ◽  
Author(s):  
Osamudiamen Idahosa ◽  
David T. Huang
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Organ Dysfunction ◽  
Early Identification ◽  
Signs And Symptoms ◽  
The United States ◽  
Medical Emergency ◽  
Suspected Infection ◽  
Portal Of Entry ◽  
Acute Organ Dysfunction

Sepsis is the presence of a known or suspected infection and a systemic inflammatory response. Severe sepsis is sepsis with acute organ dysfunction. Septic shock is a subset of severe sepsis characterized by systemic arterial hypotension or occult hypoperfusion. Severe sepsis is common, affecting more than 750 000 individuals in the United States each year with a hospital mortality of about 30%.Severe sepsis is a medical emergency that requires early identification, prompt evaluation, and treatment. The signs and symptoms of sepsis are influenced by the virulence of the pathogen, the portal of entry, the degree of organ dysfunction as well as the susceptibility and response of the host.

Meleney's synergistic gangrene: a case study

1995 ◽  
Vol 15 (6) ◽  
pp. 59-64 ◽  
Author(s):  
EA Howse
Keyword(s):  
Early Identification ◽  
Nursing Interventions ◽  
Minor Trauma ◽  
Prompt Treatment

Meleney's synergistic gangrene is caused by S aureus and streptococcus organisms. One of the identifying symptoms is the presence of extremely painful lesions, which usually form in the second week after surgery or minor trauma. The ulcers that form at the center of the lesion are usually covered by a black eschar and encircled by a gangrenous margin. With knowledge of the pathophysiology and characteristics of this process, nurses can aid in the recognition of this unexpected complication. Nursing interventions can be planned around the needs of these patients. The key to recovery is early identification of the infection and prompt treatment.

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