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Gastro Exam
 
 

Level of Consciousness

 
 
 
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Overview

Patients with hepatic encephalopathy in the setting of acute or chronic liver disease may be confused or have a reduced level of consciousness.

The Glasgow Coma Scale (GCS)

15-point scale indicating level of consciousness.
  • How to Assess

  • If the patient is not spontaneously opening their eyes, begin by attempting to elicit a response verbally. If this is unsuccessful then apply a painful stimulus such as a trapezius squeeze or a sternal rub.
If not done in this order, the examiner is unable to determine whether the patient responded to the painful stimulus or the voice.
  • Interpretation

  • The Glasgow Coma Scale (GCS)
  • Causes of Unconsciousness

  • Intracranial

  • Haemorrhage - intracerebral, subarachnoid, subdural, extradural
  • Infarction
  • Infection - meningitis, encephalitis, abscess
  • Tumour - mass effect, cerebral oedema
  • Post ictal state
  • Head trauma - vascular, hypoxia, cerebral oedema, parenchymal injury
  • Psychiatric - conversion, depression, catatonia
  • Extracranial

  • Cardiovascular - shock, hypertension
  • Infection - septicaemia
  • Metabolic - hypo/hyperosmolar states, hypo/hyperglycaemia, hypoadrenalism, hypothyroidism, hypopituitarism, electrolyte abnormality, hypoxia, hepatic failure, renal failure
  • Drugs / toxins - sedatives, analgesics, alcohol, encephalopathy
  • Physical injury - hyper / hypothermia, electrocution

Assessing Orientation

  • Ask About

  • Time - day, date, month, year, season
  • Place - floor, building, city, state, country
  • Person - full name, date of birth, address
  • Significance

  • Orientation is a quick way of assessing patients for confusion.
  • Causes of Confusion

  • Delirium - stroke, infection, intoxication / withdrawal, metabolic, neoplastic, seizure, sleep deprivation, severe pain, psychiatric
  • Dementia - Alzheimer’s, vascular dementia, lewy body dementia
  • Intellectual disability
  • Poor compliance with examination
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