Constipation and upper gastrointestinal bleed: Leading precipitating factors of hepatic encephalopathy in Indian cirrhotic patients

Background: Liver cirrhosis and its complications pose major health problems. In India, commonest causes of cirrhosis are alcohol abuse and viral hepatitis. Hepatic encephalopathy (HE) is a life-threatening complication of cirrhosis. This study aimed to determine clinical, etiological and laboratory profile of chronic liver disease patients presenting with HE. Methods: Cross-sectional study was conducted in Institute of Internal Medicine at Madras Medical College, Chennai. Seventy-five diagnosed cases of chronic liver disease presenting with hepatic encephalopathy were enrolled. Hepatic encephalopathy was clinically graded according to West Haven grading. Results: Middle aged group males comprised the largest affected group (30-50 year). Alcohol abuse was most common etiological factor. Jaundice (78%) was most common presenting complaint. Most common precipitating factors were constipation (54%) and upper gastrointestinal (GI) bleeding (45%). Thrombocytopenia was present in 78% cases while 16% cases presented with coagulopathy. The mean serum AST, ALT, bilirubin, ALP and albumin level were 90 U/l, 68.4 U/l, 9.66 mg/dl, 124.2U/l and 2.9 g m/dl, respectively. Mean serum urea and creatinine level were 43.22 mg/dl and 1.39 mg/dl respectively. Conclusion: In the specific study group, alcohol-related chronic liver disease was the commonest, with constipation and upper gastrointestinal bleeding being the leading precipitating factors for hepatic encephalopathy. (c) 2018 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.