How many stages are there for hepatic encephalopathy?

Hepatic encephalopathy is divided into four different stages, and the symptoms are different in different stages. In the mild first stage, there may be phenomena such as slow stomach movements. As the disease worsens, the symptoms will become more obvious and may even lead to coma and loss of consciousness.

1. Stage I: also called the prodromal stage. Mild personality changes and unusual behavior. For example, some patients are taciturn, while others are talkative; they are usually very steady, but suddenly show childish and rash movements, or become untidy, or spit, urinate, defecate, or take off clothes everywhere; their reactions and answers to questions are correct, but sometimes they speak unclearly and move slowly, etc. There are generally no neurological signs and no flapping tremors during this period. There is no obvious abnormality in the electroencephalogram, and the frequency of the waves may be reduced.

2. Stage II: also called the pre-coma stage. The main symptoms are mental confusion, confusion, sleep disorders and abnormal behavior. Decreased orientation and comprehension, such as vague concepts about people's names, ages, where they live, and what time it is; inability to complete simple intellectual tasks, such as what is 1+1? What shape is this object? Unclear speech, writing difficulties, abnormal behavior such as searching for clothes and touching the bed, dancing; sometimes hallucinations, mania, similar to mild mental illness. Flapping tremor, hyperreflexia of tendons, increased muscle tone and positive pyramidal tract signs are often present. Abnormal slow waves are often found on the electroencephalogram.

3. Stage III: also called the coma stage. Main symptoms include stupor and drowsiness. The patient spends most of the time in a coma, can be awakened by being called, and then falls asleep again, answers incoherently and has hallucinations. If the patient cooperates, flapping tremor can be induced. Various neuropathological signs appeared one after another. The electroencephalogram showed obvious abnormal diurnal waves and triphasic slow waves.

4. Stage IV: also called the coma stage. The patient loses consciousness and enters a coma. He cannot be awakened even when called, but still responds to painful stimuli. In a light coma, tendon reflexes are hyperactive, muscle tone is increased, the patient is uncooperative during physical examination, and flapping tremor cannot be elicited. The patient enters a deep coma, all reflexes disappear, there is no response to various stimuli, pupils are dilated, there is hyperventilation, and S waves appear on the EEG.