Medical Surgical Gastrointestinal System: Hepatic Encephalopathy & Coma

Hello Everyone, here is a Gastrointestinal dysfunction lecture on hepatic encephalopathy & coma made easy to understand to help aide in your study sessions. I have gathered all of the important information from (Brunner & Suddarth 12th edition) that will prepare you for your nursing test whether it is for school or NCLEX.

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First, hepatic insufficiency may result in encephalopathy because of the inability of the liver to detoxify toxic byproducts of metabolism. Second, portal-systemic shunting, in which collateral vessels develop as a result of portal hypertension, allows elements of the portal blood (laden with potentially toxic substances usually extracted by the liver) to enter the systemic circulation. Ammonia enters the brain and excites peripheral benzodiazepine-type receptors on astrocyte cells, thus increasing neurosteroid synthesis; this then stimulates gamma aminobutyric acid (GABA) neurotransmission. GABA causes depression of the central nervous system (Hauser, et al., 2007). Ammonia inhibits neurotransmission and synaptic regulation (Onion, 2006), producing sleep and behavior patterns associated with hepatic encephalopathy.

Other factors unrelated to increased serum ammonia level that can cause hepatic encephalopathy in susceptible patients include excessive diuresis, dehydration, infections, surgery, fever, and some medications (sedatives, tranquilizers, analgesics, and diuretics that cause potassium loss). Additional causes include elevated levels of serum manganese (Hauser, et al., 2006), as well as changes in the types of circulating amino acids, mercaptans, and levels of dopamine and other neurotransmitters in the central nervous system (Feldman, et al., 2006). Mercaptans are toxic metabolites of sulfur-containing compounds that are excreted by the liver under normal conditions. Mercaptans and these other so-called “false” neurotransmitters may be generated from an intestinal source or from metabolism of protein by the liver and, with defective hepatic clearance, may precipitate encephalopathy.

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