الفهرس 
Liver CirrhosisOnly 14 pages are availabe for public view
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Abstract
L
iver disease is a major cause of mortality and morbidity worldwide. In most cases, liver-related mortality results from complications of chronic liver disease such as cirrhosis and hepatocellular carcinoma.
Cirrhosis is a diffuse hepatic process characterised by fibrosis and conversion of normal liver architecture into structurally abnormal nodules, that may occurs over weeks or years. Liver cirrhosis is associated with many other complications as ascites, minimal and overt hepatic encephalopathy which are associated with severe impairements in health-related quality of life.
MELD score is a scoring system for assessing the severity of chronic liver disease. It is a reliable measure of mortality risk in patients with end-stage liver disease and suitable for use as a disease severity index.
Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities in patients with liver failure, after exclusion of other known brain diseases. Features of hepatic encephalopathy include personality changes, intellectual impairment and reduced levels of consciousness. In the advanced stages, it is called hepatic coma. Overt hepatic encephalopathy occurs in 30-45% of patients with liver cirrhosis. The term minimal encephalopathy is defined as encephalopathy that does not lead to clinically overt cognitive dysfunction, but can be demonstrated with neuro-psychological studies.
The psychometric hepatic encephalopathy score (PHES) is a standardized test battery including NCT-A and B, the line- tracing test, the serial-dotting test and the digit symbol test.
This battery examines many of the abnormalities seen inpatients with MHE, including motor speed and accuracy, visuo- spatial orientation, visual perception, visual construction, attention, concentration, and,to a lesser extent, memory. PHES has a prognostic value for the occurrence of overt encephalopathy and mortality in cirrhotic patients.
The aim of our work was to evaluate the relation between MHE and MELD score in patients with liver cirrhosis.
The study was concluded on 50 subjects who were divided into 2 groups: group (1) which consists of 40 subjects with liver cirrhosis and group (2) which consists of 10 healthy subjects as a control group. All subjects gave their wtitten informed concent. The following exclusion criteria were applied for the control group: (1) Presence of chronic liver disease, neurological or psychiatric disorders, or other diseases that can affect cognitive function.(2) A past history of chronic liver disease, neurologic or psychiatric disorders.(3) Consumption of psychotropic drugs. (4) Alcohol consumption during the last 6 months. (5) Inability to read and write.The following exclusion criteria were applied for the liver cirrhosis group: (1) A history of overt hepaticencephalopathy. (2) Consumption of psychoactive drugs during the past 2 weeks. (3) Presence of neurological or psychiatric disorders. (4) Presence of significant comorbidity, such as heart, respiratory, or renal failure. (5) Presence of hepatocellular carcinoma or other malignancy. (6) Alcohol consumption during the last 6 months. (7) Inability to read and write.
All patients were subjected to the following:
Full history taking.
Full physical examination including abdominal examination.
Laboratory investigations including:
Complete blood count (CBC), liver function tests including: SGOT, SGPT, S.bilirubin and S.albumin, kidney function (S.creatinine).
Abdominal ultrasonography.
Calculation of the MELD score for the patients.
Brain CT scan to exclude any brain lesions.
Neuro-psychometric testing and calculation of the psycho- metric hepatic encephalopathy score (PHES).
Our results denoting:
Prevalence of MHE was 47.5% among cirrhotic patients.
A highly statistically significant correlation between MELD score of >15 and MHE with a sensitivity of 84.21% and a specificity of 76.19%.
A highly statistically significant difference between MELD score of patients with normal psychometry (15.71 ± 7.58) and MELD score of patients with abnormal psychometry (25.11 ± 8.69) with (p-value 0.00).
Our study also showed a highly statistically significant difference between PHES of patients with MHE (-9.21 ± 3.52) and that of patients without MHE (0.29 ± 2.15), (t 10.410, p-value 0.000), and a highly statistically significant difference was also found between PHES of the control group (1.5 ± 2.51) and PHES of the patient group (-4.23 ± 5.58), (t 3.146, p-value 0.003).
Conclusion
The prevalence of minimal hepatic encephalopathy in the present study was 47.5%, and a MELD score of >15 was significantly associated with MHE.