UNCOMMON CASE OF HEPATIC ENCEPHALOPATHY DUE TO HEPATITIS ‘A’

A 29 years old woman was shifted from other city in semiconscious condition. She was having jaundice due to hepatitis A virus infection. To begin with she had loss of appetite and weakness followed by nausea and vomiting with yellow discoloration of eyes and yellow coloured urine. Her blood tests of liver were abnormal and suggested hepatitis A with high counts of liver enzymes. After two days of hospitalization, her condition deteriorated. She remained drowsy and later became unconscious in spite of ongoing treatment. She was advised to move to a higher center for further treatment. On admission she had mild respiratory distress and low oxygen percentage. She was admitted in ICU. Oxygen as well as treatment to reverse her unconsciousness were initiated aggressively. Next day morning her condition was better. She was following verbal commands and was communicating. However her level of consciousness deteriorated further in evening. Treatment was intensified accordingly. With continuous intensive care, she became fully conscious after two days. Later she was shifted to room where her condition kept improving and she was discharged from the hospital.

Hepatitis A is one of the many causes of Jaundice. However it less often causes life threatening illness. In our patient the disease took a fulminant course after six to seven days of illness.

How Hepatitis A occurs?

Hepatitis A occurs due to ingestion of food or water contaminated with virus. Once ingested, virus crosses walls of intestine and through blood it enters in liver. Within the cell of liver, by using the machinery of the cell, it multiplies. Jaundice may occur after two weeks of its entry in to your body. However significant liver failure in Hepatitis A is rare and occurs in 0.015 to 0.5% patients only.

These are the vacation months. You may travel and eat and drink outside for many days. Water borne diseases are frequent in this months. Weather remains hot and you have to consume liquids frequently. This exposes you to the risk of water borne diseases.

What happens in hepatitis?

Hepatitis means inflammation of live. In simple words it is the swelling of liver. The cells of liver become sick and can’t detoxify toxins efficiently. Apart from damage, large number of liver cells may die. One important toxic substance that hampers cognitive functions is Ammonia. Ammonia is produced in large bowel due to degradation of protein residues by colonic bacteria even in healthy state but it is quickly metabolized by liver. When liver can’t remove it from blood, levels of ammonia increase. With rising ammonia levels in brain, cells known as astrocytes starts swelling creating compression of important cells and reducing their function manifested as reducing cognitive functions progressing to drowsiness to coma. If not managed quickly, it can lead to death.

How to prevent it?

Good hygiene practice:

• Wash your hands thoroughly with soap and water before eating or preparing food.
• Take extreme care while changing a diaper or handling excreta. Virus shading in stools occur before development of symptoms.

Practice safety precautions when travelling:

• Peel and wash all fresh fruits and vegetables yourself.
• Prefer eating heated fresh food. Avoid raw or undercooked food
• Avoid eating from unhygienic places.
• Drink bottled water or RO / purified water wherever you stay during travelling.
• If no such facility available, boil water before drinking it.
• Avoid all beverages of unknown purity, with or without ice.