Hepatic Encephalopathy

[@Snowchris1]

I had liver disease and went into a coma twice. I clearly remember having the worst headache in my life both times as I was going into the coma. I had a liver transplant and doing remarkably well so far....

[@ARVINDSINGH-db5et]

After coming from coma how do you recover.how much time it's taken

[@sushilsp8746]

My father is going through same condition...but we can't afford transplant 😣

[@anshulbhuvan1111]

@@sushilsp8746 how is everything now?

[@sushilsp8746]

@@anshulbhuvan1111 He passed away in February 😞

[@anshulbhuvan1111]

@@sushilsp8746 sorry for the loss, stay strong for ur family brother ❤️

[@thomasmagabe740]

Was nice and informative👏👏👏 Pleas you can add the latest drugs used in hepaticencephalopathy treatment like LOLA and their mechanism of action also it would make it better. Any way thanks

[@floweryellow427]

Perfect explanation, thank you!

[@Roscoesadie]

Covid then jaundice then this

[@ambersykora352]

Same here. Started with COVID, then vomiting constantly for almost a year, with extreme edema in my legs, and an infection in hospital for week then almost a year later hospitalization for a month. Every time I got sick with something it just got worse and worse.

[@LuisDiaz-he3fc]

By far the best video I have ever seen for the explanation of ammonia’s role in hepatic encephalopathy. Thank you sir

[@Bipolar_Spike]

HE is the absolute worse to have to deal with. I hate it and it is so scary because you never know when an episode will happen to you.

[@clearinsight2696]

I'm so confused, I was diagnosed with hepatic encephalopathy. I asked my hepatologist what that meant in terms of my everyday life. She would never answer the question. Based on my medical records the numbers seemed really high. I switched to a gastroenterologist who was much more knowledgeable but he didn't give me a direct answer either. However, his level of treatment was on point based on what I read. My report also said I have portal hypertension. Again, I never got an answer to what that meant for my day to day life. I had the typical symptoms lethargy, forgetfulness, speech issues, daytime Sleepiness, ascites etc. This was all shocking to me as I never drank alcohol, use tobacco, marijuana and seldom used medication. A biopsy of my liver showed sarcoidosis which explains the diagnosis but I still don't understand what condition my liver is in and the impact short / long term.

[@Snako]

I hope you're doing well!

[@clearinsight2696]

@@Snako Thanks for asking, I'm honestly taking it one day at a time. I let my body determine my day and that brings me peace. I hope all is well with you.

[@Snako]

@@clearinsight2696 I know people who've been diagnosed with sarcoidosis , Hope your organs keep up and stay shap, Eat well!

[@clearinsight2696]

@@Snako I surely will

[@dominic5279]

Hi, how you are doing now? @clearinsight2696 Have you changed your diet and exercise? Have you begun any medications/treatment? I am in a very similar situation (rarely drink alcohol, no smoking/drugs) and recently found out that I have high ALT - 90/AST - 48 and having trouble with speech, concentration, brain fog, bloating, belching, laugh at inappropriate times, itchiness. I am waiting to hear back to see if they will do liver ultrasound but am worried.

[@imperiusss]

Sir please continue the ´´Approach´´ clinical video series. They were really an unique resource. thank you !! :)

[@StrongMed]

Don't worry - more are coming! Filming them is more involved than with most of my other videos, so I need to wait for a stretch of a few days in a row that are completely free (i.e. no teaching, no patients, kids in school). First batch will be peripheral edema, GI bleeding, headache, and polyuria. Second batch will be (I think): jaundice, diarrhea, hematuria, and abdominal pain.

[@wolfpytlak2786]

@@StrongMed those videos will be worth their weight in gold, to much of our education and resources are desease specific, and then people wonder why there is so much missdiagnosis.

[@roshaniaryal2546]

Lactulose moa part May be it should be it decreases the uptake of ammonia by gut flora?! Or am I getting it wrong!

[@paulenus2098]

Thank you Dr. Strong for another short but very well structured Video. If I may ask, whats your opinion on LOLA i.v. (L Ornithin L Aspartat) as treatment for HE Exacerbations ? We use it quite frequently in Germany for the first days of acute treatment.

[@bollywoodbreak4847]

Thanks Sir. The video was very informative. Sir my mom has ESLD. She developed HE due to constipation earlier and since then she is taking Lactulose and Rifaximim. Now even with this medication yesterday it took us around half hour to wake her up. She is 82,bed ridden now and has astrixis. What do you suggest?What is the prognosis?Thanks.

[@the_true_medicine]

Thank u sir . I have important note, convulsions are classically not a feature of hepatic encephalopathy and if it present, shift your thinking to co-existing electrolytes abnormalities .

[@StrongMed]

Yes, I agree.

[@benjaminazumah9833]

Please isn't lactulose rather increasing GI transit time since it is also an osmotic laxative? At 10:55, the video says otherwise.

[@normapena913]

Sad to said but im going threw it an much much worse 🥰 really we God ois really fun me to join my mother 🥰😇💖💯

[@MaryBritt2014]

Learned most of this the hard way in 2016 when my wife had liver failure. It’s An early sign for many issues. See a Dr. ASAP if you’re having symptoms

[@naturalbreed3745]

Ammonia is by far the annoying one when i eat protein my joints and muscles feeling so much better my skin gets better but my head feels like is about to explode and then i do lactulose enema tp get it off. Salicylate is another annoying one but not as bad as ammonia.

[@normapena913]

I'm a fighter thanks God 🙏😇

[@franknstein5376]

Just dropping a comment to say that your work on these videos is exceptional. I'm revising right now on gastroenterology, and cannot imagine how I would go about without thiskind of comment (not just as a clarification, but also as a way to continue studying if you are eyes are not even following the words on your book/notes anymore). Thank you from Italy!!

[@rumisfordrinkingnotburning]

This guy sounds like trey parker no bs.

[@saidibrownc5545]

well explained sir

[@AliRaza-bu5cn]

The best video I have ever watched on any topic.. Keep it up sir🙂

[@ankitchellani]

Superb video for a quick revision. But I would like to ask about the role of single pass albumin dialysis or other techniques such as MARS and simple hemodialysis in patients of HE with or without HRS, Thank you.

[@talonkikit]

this is so very well done! salute Sir! NU202 Student. thank you.

[@sadigsaeed]

Thanks sire love you

[@luca-marianioan2324]

Thank you doctor for your great work & effort. I personally would love to see a lung auscultation and an anemia videos coming. Keep up the good work !

[@suadacheema6442]

Which single test is for diagnosis of hepatic encephalopathy.

[@glamourpurrs8464]

Is the only way out of this is via coma?

[@coinmacdonnell4856]

great video, i have end stage liver disease...on the transplant list, along with severe ascites 5-liters drained every 7 days (via parathentisis-gut & thoro thentesis -lungs -painful) esophageal varices banded twice, jaundacing, insomnia bad, & the TIPS proceure. had lactulose as well & they put me on rifaxamin & am getting bad stomach aches, pounding headaches & ringing in the ears i want to stop the rifax because of these side effects any advice? wonderful if all this is worth it thanks Boston, MA

[@keewee23]

do you have anxiety?

[@rorybory123]

Check out a supp called "Fibrenza". It heals All scar tissues in the body, including Cirrhosis.

[@aneliseisfree3602]

Hyperbaric Oxygen Therapy (HBOT)? Low Animal Protein Diet? Vitamin D3 and K2-MK4. Lugol's Iodine and Lysine. NO Crash Diets. Keep potassium levels up ... could use NoSalt or other salt substitute. No Grains except Oatmeal. No Sugars except those naturally occurring in fruit. (Avocado, Strawberries, Watermelon, Blueberries, etc). Hope these suggestions help you.

[@theresageiger584]

@@aneliseisfree3602 HBOT??

[@theosenpai3621]

How are you now? Are you still alive? Did you got the transplant sir? I hope ur best, I am sufferint of liver cirrhosis stage 4 with mild ascites, and I am very afraid, I am only 19 years old and wanna live this life....

[@purnoork5249]

This video is gold

[@rebeccagutierrez1960]

My dear husband suffered exactly this, hours before passing.

[@goofybutserious4807]

I'm sorry to hear this. May he be with peace ❤️

[@virtuelight5979]

How can you rule out acute liver failure in new found HBV - cirrhosis patient, which present coma degree I with no SBP, hepatorenal, varices bleeding present ?(can’t order ADN-HBV test)

[@mangos2888]

I wish it mentioned how long it would take to progress from stage 1 to 4 if untreated…

[@StrongMed]

There is no specific time frame. If the cirrhosis is well compensated, a patient may never progress beyond grade 1, whereas if there is an acute inciting event (e.g. GI bleed, spontaneous bacterial peritonitis), encephalopathy may dramatically worsen over a very short time interval, but then rapidly improve with treatment. Grades of hepatic encephalopathy are much more dynamic than stages of cancer, or classes of heart failure.

[@mangos2888]

@@StrongMed Oh! I did not expect you to respond to a 2 year old video. Thank you!

[@melm295]

@@mangos2888 I’m an extremely rare case, as my liver is in optimal condition + chronic HE from TIPS + my brain is hyper sensitive to ammonia , but can go from a minor stage 1 to 2 or 3 in hours. Sometimes in minutes if I’m dehydrated. It’s such a subjective experience and there are so many unknown factors that contribute.

[@SKARTHIKSELVAN]

Thanks for your video.

[@Badhon143]

Thanks. Lola sachet can be used for this patient . Note : patient already take lactulus. Indever

[@mohammedelsharawy2295]

Wonderful danke schon

[@sunving]

Nice music also , somewhat strange :) Good lecture Dr thanks.

[@nylevemark5479]

Can you pls explain the action of ammonia causing diarrhea to patients taking it. Thanks

[@jmjung9]

My father is in the hospital with this now. I'm worried this means end stage.

[@carolinehurst3936]

Why “Ave Maria”? Although I like it.

[@ishanmewara44]

Brief and beautifully explained.

[@vviperbeehumble1410]

Doing exam on Monday ...this makes it so understandable...❤❤

[@mosaabmohammad8552]

Thanks a lot.

[@sahartaher9490]

Thank you so much , you are my hero🤩🤩

[@aliturki4806]

تدللين

[@aliturki4806]

و كل عام و انتي بالف خير

[@shir9080]

absolutely amazing video! thank you

[@prashantgyawali6801]

nice for additional small information.. it helped my revision

[@copperlight]

awesome. i will check out more vids

[@georgetucker336]

Very well explained. Is Lactulose a better choice than Rifaximin or (Xifaxin)? These pills are very expensive.

[@StrongMed]

To the best of my understanding of the currently available literature, lactulose and rifaximin have similar efficacy in preventing episodes of encephalopathy, lactulose is much cheaper, and rifaximin is better tolerated (due to lactulose causing bloating and diarrhea). The combination of them is probably more effective than either alone. Even in the US where cost is often inappropriately ignored, the difference in price between lactulose and rifaximin is high enough that lactulose is typically the first treatment used. The only time I would consider starting with rifaximin right off the bat would be if the patient specifically told me that cost was not an issue at all.

[@georgetucker336]

@@StrongMed Thanks for the information and reply. The hospital started the Rifaximin. Not knowing the cost until I started to fill the medication, when out of hospital. Filled one. Extremely expensive. Did not order any more, but tried to find a way to pay less for it. Lactulose is used at higher doses. It took the Dr. a while to understand I could not afford the cost. The insurance covered it while in the hospital. The Dr. increased the Lactulose. Thanks again.

[@margoparkerschellerhaadent8042]

Push your docs to request special circ for your insurance to cover it- assuming here. I’m on both now, helping brain fog for sure. Less traumatic BMs. I know, right?! 😇💪🏾 8 years after 19 meld, ascites and level 3 HE death sentence of ESLD, LOTS of us are proving the liver has mighty powers. Don’t give up, and learn as much as possible about your condition. ❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️💪🏾✌🏾

[@emmanuelkay8574]

Well packed - damn, Clapp💞

[@winnieprune4900]

Can hepatocellular carcinoma cause hepatic encephalopathy? Or is it only cirrhosis?

[@StrongMed]

Any disease which severely affects the entire liver can cause hepatic encephalopathy. This is most typically seen with cirrhosis, but could also be seen in severe acute hepatitis, or in hepatocellular carcinoma (HCC) superimposed on chronic hepatitis. I have not personally heard of HCC alone causing encephalopathy, but if the tumor burden was large enough (i.e. the primary tumor was very large, or there were many different sites of HCC) I suppose it would be possible.

[@winnieprune4900]

@@StrongMed Thanks 🥰

[@shubhamdhurde3799]

Thank you sir❤️

[@rovert381]

Indeed this is strong medicine 🙌

[@mengkorng4278]

How long does HE grade 1 develop to HE grade 4 ?

[@StrongMed]

There is no specific time course - it depends on factors such as the severity of the liver disease, whether or not the patient is already on some amount of treatment for HE, and what the specific trigger is for the HE. Many patients with chronic cirrhosis already on modest amount of lactulose can remain in grade 1 for days or even weeks. Other patients with acute liver failure complicated by a GI bleed can progress to grade 4 in a single day.

[@sunving]

Thank you Dr Strong.

[@michaelmuldowney6863]

Exceptional video!

[@drmuaazali7649]

Thanks for your great work 💙

[@theresageiger584]

I need help asap

[@amirbass5018]

awesome,thanks a lot

[@sunving]

thanks Dr Strong

[@aureasantiagotorres6680]

Thanks

[@SHAMSUL477]

His voice is similar to Armando Hasudungan

[@StrongMed]

If only I could draw like Armando!

[@SHAMSUL477]

@@StrongMed....Sir you're way of teaching wonderful...👍👍

[@Dobrusska]

Great information.

[@Juan-ud3if]

👍👍👍👍

[@yogeshjhajharia9820]

aewsome

[@lashklashk4179]

A PLUS

8:00

[@venkybly]

Tq

[@kamalkhan6244]

Is it curable?

[@StrongMed]

Hepatic encephalopathy is caused by severe liver disease. If the underlying liver disease is curable (e.g. alcohol cessation in a person with alcoholic hepatitis, liver transplant in a person with cirrhosis), then the encephalopathy would be cured too.

[@alejandroburgara5091]

Perfect!!

[@fourelementswolf]

I might be missing something, but does anybody know how hypercapnia and hypoxemia act as a risk factor for hepatic encephalopathy?

[@benjaminazumah9833]

You are not alone. But I'm sure is as a result of decreased integrity of the BBB.

[@abumais100]

Thanks sir Ur awesome Would like explain to us respiratory failure and its management please

[@jjzazueta957]

great video. i have been taking lactulose off and on for 11 yrs now . nobody ever explained how it works so it was great to to have the visual aids as my memory is compromised.

[@chrishanlon9215]

IVE BEEN TAKING LACTULOSE ON AND OFF FOR TWENTY YEARS ! ITS GOOD STUFF.

[@medicinemadeeasy8235]

Wow, its perfect! 🖤

[@teguhrimba6009]

Gak paham terjemahane

[@gauravdocmed]

Exceptional teacher

[@iSylvan]

Great video, thank you, dr Strong! :)