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Episodic Hepatic Encephalopathy: A Problem of all Specialties

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Abstract

COMA is a well-recognized and much-feared complication of hepatic disease, especially of cirrhosis. In recent years the spectrum of neuropsychiatric symptoms due to hepatic disease, varying from subtle personality change, episodic stupor, and transient coma, to chronic dementia, has been more fully appreciated.1 We are reporting four cases of hepatic encephalopathy which were not suspected either by the referring physicians or by the clinicians here who first examined the patients. The first patient was admitted to the vascular service for study of edema of the lower half of the body and suspected “thromboembolic strokes.” The second patient was admitted to the proctologic service because of severe rectal hemorrhage associated with possible small strokes. The third patient was admitted to the gastrointestinal service because of jaundice, splenomegaly, and recurrent anemia after several gastrointestinal hemorrhages. The fourth patient was admitted to the neurosurgical service because of stupor thought to be the result of a cerebral injury incurred in an automobile accident. In each of these patients the elevation of the blood ammonium nitrogen (hereinafter designated as B.A.N.) was of decisive importance in the diagnosis. The normal range was from 36 μg. to 75μg. per 100 ml. The blood was drawn into syringes containing heparin, and the determinations were performed within 20 minutes. The method was a modification (by W. R. F.) of the Conway Method.

Subtle personality change may escape notice for long periods, and its relationship to known hepatic disease may not be recognized or the mental disorder may progress to . . .


 

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