Mental disorders associated with digestive diseases
Introduction
Introduction to mental disorders associated with digestive diseases Since the 1950s, brain diseases caused by liver diseases have been reported frequently. Chinese scholars have reported on the early stages of hepatic encephalopathy and mental disorders of different liver diseases since 1963. Hepatic encephalopathy (hepatic encephalopathy), also known as hepatic encephalopathy, is a syndrome caused by severe liver disease, characterized by metabolic disorders and characterized by severe physical symptoms and neuropsychiatric symptoms. Because liver function is closely related to the brain, once the liver function is severely impaired, psychiatric symptoms can occur clinically. Psychiatric symptoms are mainly characterized by disturbance of consciousness and coma. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: gastrointestinal bleeding
Cause
Causes of mental disorders associated with digestive diseases
Cycling disorders say (20%):
The surgical shunt between the liver failure and the portal vein or the naturally formed collateral circulation may be the basis of its pathophysiology. The shunt between the intrahepatic and extrahepatic portal veins causes the toxic substances in the portal vein to bypass the liver cells and the lateral branches. Entering the systemic circulation to the brain, causing brain dysfunction.
Neurotransmitter says (15%):
The presence of hepatic insufficiency or portal-to-body collateral circulation prevents certain aromatic amines from the gut, such as hydroxyphenylethanolamine or norxifolib, from being similar to norepinephrine and dopamine. , to produce a competitive effect, causing obstacles in the transmission of synapses, affecting the activity of the brain stem network upward activation system, resulting in coma.
Ammonia poisoning theory (15%):
It is believed that hepatic encephalopathy is caused by increased blood ammonia concentration. It is pointed out that the concentration of ammonia in cerebrospinal fluid is higher than that in blood in hepatic encephalopathy. Ammonia can cause acidosis, hypoxia can increase the toxin of ammonia, and some people observe hepatic encephalopathy. EEG abnormalities are in the same direction as ammonia levels, but the pathogenesis of hepatic encephalopathy is obviously not explained by the increase in ammonia concentration, because hepatic encephalopathy only accounts for 80% of the increase in blood ammonia.
Amine metabolism disorder (20%):
Amine metabolism disorder is associated with disturbance of consciousness. 5-HT increase can induce coma. 5-HT reduction can also cause cerebral metabolic disorder. After injection of 5-HT in hepatic encephalopathy, EEG changes from slow wave to fast wave, 5- Slow waves occur when HT is reduced.
Electrolyte metabolism disorder (15%):
The reduction of blood potassium caused by various reasons before hepatic encephalopathy can cause patients to quickly fall into a coma, and low-magnesium can also cause mental disorders. Others have also suggested the effects of amino acid and thiol metabolism disorders on hepatic encephalopathy.
The predisposing factors of hepatic encephalopathy include gastrointestinal bleeding, infection, fever, anesthetics, antipsychotic application, abortion, and drinking.
The etiology of this disease has not been fully elucidated so far, and most of them are considered to be associated with circulatory disorders, neurotransmitter transmission disorders, ammonia poisoning, amine metabolic disorders (5-HT increase can induce coma), and electrolyte metabolic disorders. First, due to various liver diseases, advanced liver Depletion, detoxification, so that the toxic substances ingested or produced in the gastrointestinal tract are not effectively detoxified by the liver, resulting in a decrease in essential substances for the brain to maintain brain function; at the same time, liver function damage leads to increased blood ammonia, hypoxia Electrolyte metabolism disorders such as potassium deficiency, low magnesium, and amine metabolic disorders such as some neurotransmitters (hydroxyphenylethanolamine, norfosin, etc.) cannot be removed in time, competing with NE and DA, affecting the transmission of nerve impulses, etc. Second, the use of gastrointestinal bleeding, infection, fever, alcohol and anesthetic sedatives, these factors have an important role in the occurrence of mental disorders.
Prevention
Prevention of mental disorders associated with digestive diseases
Liver lesions complicated with hepatic encephalopathy, there are many incentives, such as active treatment of the primary disease, timely removal and avoiding predisposing factors, generally can prevent the onset.
1. Limit high-protein diet: High-protein diet is one of the most common causes. In the past, patients with a history of hepatic encephalopathy, protein <70g / d; attack period <20g / d, after the recovery of the disease, can only increase every 3 to 5 days About 10g, the highest is less than 50g.
2. Keep the stool smooth: the stool contains ammonia, amines and other toxins. When a large amount of toxins are absorbed during constipation, it can induce encephalopathy. If necessary, you can take lactulose or dilute vinegar enema.
3. Timely discovery and control of gastrointestinal bleeding: cirrhosis due to esophageal varices, portal hypertension, easy to cause esophageal and gastric bleeding, blood in the protein produced in the intestine can induce encephalopathy, it should always pay attention to stool color, massive bleeding When the stool is tar-like, a small amount of bleeding stool color changes little, should be promptly sent for occult blood test.
4. Prevention and control of infections, fever; improvement of electrolytes and acid-base balance; ban on drinking alcohol and caution with anesthetics, sedation, sleeping pills, etc.
5. Supportive psychotherapy for patients, psychological counseling, targeted guidance, supplemented with comfort, support and counseling, eliminate their nervousness and anxiety, eliminate bad emotional factors can keep the central nervous system function normal, Helps prevent mental disorders from occurring.
Complication
Distress disorders associated with digestive diseases Complications, gastrointestinal bleeding
Can be combined with blood, perforation complications.
Symptom
Symptoms of distress disorders associated with digestive diseases Common symptoms Hepatic dysfunction Drowsiness Liver dysfunction Drowsiness hallucinations Mental disorders Abdominal water coma
1. Acute hepatic encephalopathy: Acute hepatic encephalopathy refers to hepatic parenchymal damage caused by primary liver disease, and mental disorders and neurological symptoms associated with severe hepatic insufficiency, which are more common in severe hepatitis such as acute severe hepatitis and subacute severe Hepatitis is characterized by disturbance of consciousness.
(1) Mental disorders:
1 Depression state: At the beginning of the disease, the performance is slow, the silence is less, and the activity is reduced.
2 Excited state: A small number of patients have anxiety, excitement, excitement, crying, shouting or frivolous performance.
3 disturbance of consciousness: lethargy and consciousness, drowsiness, paralysis or confusion.
4 hallucinations or illusions: the erroneous, illusory, and then into the coma.
5 mental retardation: a small number of patients may have transient or irreversible forgetting and even dementia in the later stages of the disease.
(2) Neurological symptoms: more often occur after psychiatric symptoms, such as unclear articulation, flapping tremors, etc., nystagmus often occurs in the coma aura, which is often a coma precursor, and may have seizures, myoclonus , pathological reflex of increased muscle tone, etc.
2. Chronic hepatic encephalopathy: Chronic hepatic encephalopathy refers to secondary or circulatory encephalopathy in the course of the disease. Due to liver tissue damage, mental disorders and neurological symptoms associated with hepatic insufficiency occur sharply. The disturbance of consciousness is chronic hepatic disease. One of the main symptoms of encephalopathy is clinically mostly lethargy, lethargy, disordered state or coma, and can also be manifested as persistent mental disorder.
(1) Mental disorders: often changes in personality and intelligence are more obvious, such as temper becomes irritable, emotionally cold and embarrassing, rash, naive, irritating, lack of courtesy, behavioral disorders and disturbances of consciousness often appear at the same time and are not easy to divide, common Behavioral disorders, such as inverted pants, public squatting, etc.; intelligence is characterized by memory loss, lack of concentration, slow understanding, difficult thinking, monotonous speech, poor judgment and understanding, even difficult to complete simple work Later, entering the state of dementia; occasionally the state of illusion delusion, the course of disease can last for several months to several years.
(2) Neurological symptoms: mainly for flapping tremor, hand and foot dyskinesia, myoclonus, dysarthria, pyramidal tract sign, cerebellar symptoms, Parkinson's syndrome, etc.
(3) EEG findings: early display of diffuse bilateral high-amplitude waves, followed by synchronous high-amplitude waves, coma deepening can have characteristic three-phase waves, mostly in the frontal lobe, bilateral symmetry.
3. Symptom staging: Take acute hepatic encephalopathy as an example:
No. 1: Presenting mental exercise inhibition, retardation, less movement, less words, some euphoria, more irritability, etc., even with mild flapping tremors.
The second period: more common drowsiness or lethargy or shouting, restlessness, and there are flapping tremors, pyramidal tract signs and so on.
No. 3: Drowsiness, paralysis or disorder, obvious tremors, myoclonus, seizures, etc.
Examine
Examination of mental disorders associated with digestive diseases
Meet the positive test results of the primary disease laboratory.
Meet the primary disease auxiliary examination results.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with digestive diseases
diagnosis
First, according to the history of liver disease and laboratory abnormal liver function tests, the diagnosis of primary liver disease is clarified. At the same time, the diagnosis of hepatic encephalopathy is made based on the nature, characteristics, outcomes and distribution of mental symptoms.
1. In the case of liver enlargement, jaundice, bad breath, ascites or flapping tremor, severe liver function abnormalities.
2. If you find inhibition or sleepiness, lethargy or restlessness or euphoria, you should consider early signs of hepatic encephalopathy.
3. If there is excitement, aggravation or ignorance, less movement or lethargy, it should be considered as a state of hepatic encephalopathy.
4. When there is drowsiness, coma or evolution from excitement.
5. Exclude other diseases that cause disturbance of consciousness.
Differential diagnosis
Except for other diseases that cause mental disorders.
