What is Hepatic coma?

Alteration in the behavior, consciousness and some other neurological functions that occur in the parenchymatous hepatic disorder are collectively termed as hepatic coma.

Causes:

(1) Virus hepatitis, (2) Cirrhosis of liver, (3) Biliary cirrhosis, (4) Toxic hepatitis, (5) Infantile cirrhosis of liver, (6) Hepato toxic drugs, (7) Carcinoma of liver, (8) Portal hypertension, (9) Toxic nitrogenous products are absorbed from the large gut, (10) Defective synthesis of urea in the liver, etc.

Signs and Symptoms

(A) Stage of pre-coma

(1) Alteration in behaviour.

(2) Impairment of memory and other intellectual functions.

(3) Confusion and even delirium.

(4) Slurring of the speech.

(5) Inversibn of sleep rhythm.

(6) Convulsion—local or generalised.

(7) Restlessness and even after some time the patient may shy unnecessarily

(8) Disorientation about space time and persons.

(9) Flapping tremor in the outstretched hand and fingers, wrist and even in the shoulder (Bat’s wing tremor).

(10) Extra-pyramidal type of rigidity.

(11) Ankle clonus, although plan ten may be flexor.

(B) Stage of coma

(1) Patient is in deep coma,

(2) Muscles are flaccid.

(3) Planter may be extensor absent.

(4) Deep reflexes absent. [Cerebral disturbance (encephalopathy) is the cardinal manifestation of hepatic coma.]

Diagnosis

(1) Liver function tests are depressed. (2) B. B. G. may show some changes. (3) Urine examination may show leucine and tyrosine crystals. (4) Blood ammonia levels—preferably in samples of arterial blood.

Treatment

(1) Complete bed rest. (2) Diet should contain more carbohydrate and less protein. (3) Sedatives (2) Good food and polyvitamins may be effective. (4) Drugs—sedate cause of anxiety and treated