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Richard Stefanacci DO, MGH, MBA, AGSF, CMD
Thomas Jefferson University
Jefferson College of Population Health
Vinod Rustgi MD, MBA
Robert Wood Johnson University Hospital – New Brunswick
New Brunswick, NJ
A large proportion of elderly residents in long-term care (LTC) facilities experience significant mental decline as a result of progressive illnesses such as Alzheimer’s and Parkinson’s disease. Associated cognitive and behavioral issues pose serious diagnostic and therapeutic challenges to individualization of care. A highly prevalent, but less recognized change of mental status occurs in a majority of patients with longstanding cirrhotic liver disease as the result of buildup of serum ammonia due to inadequate breakdown of ammonia, leading to toxic effects on the brain. Symptoms of this hepatic encephalopathy (HE) are subtle at first, but over many years progress to impairment in personality, consciousness, intellect and neuromuscular function. This slow progression, as well as the sporadic nature of HE make it difficult to diagnose. This is unfortunate, because most cases of HE can be safely and effectively treated with lactulose and rifaximin, which work in concert at the intestinal level to favor the breakdown, conversion and elimination of ammonia, this treatment combination is supported as a 1A1 recommendation in the 2014 practice guidelines of the AASLD/EASL. For those patients non-responsive to these therapies, several alternative therapies are available. This webinar guides providers through the means by which an interdisciplinary team of LTC healthcare providers can, through knowledge, vigilance and care coordination, identify new cases of HE at an early stage, then implement an individualized care plan leading to remission of HE episodes.
- Understand the prevalence of hepatic encephalopathy (HE) in LTC residents, its pathophysiology, and its effects on mental state
- Develop competence and confidence in diagnosing HE and distinguishing it from symptomatically similar diseases
- Recognize the severity grades of HE (West Haven Criteria) and the symptoms associated with each
- Explain the efficacy and safety of lactulose and rifaximin as mainstay of treatment of HE
- Review alternative and adjunctive treatments for HE, including embolization of portosystemic shunts, diet, exercise, branched chain amino acids (BCAA), l-ornithine-l-aspartate (LOLA), probiotics, liver transplantation and palliative care.
- Identify the roles and responsibilities of the LTC interdisciplinary team in diagnosis and treatment of HE in these patients and develop a process for your facility to implement.
Webinar ID: 533-370-563
Provided by a grant from Salix
1.0 Contact Hour per Webinar
These CE activities are jointly provided by Terri Goodman & Associates collaboratively with NADONA
Terri Goodman & Associates is an approved provider of continuing nursing education by the Texas Nurses Association – Approver, an accredited approver by the American Nurses Credentialing Center’s commission Accreditation This activity is provided through an unrestricted educational grant from Salix.
Participants must complete entire activity. No partial credit will be awarded. Participants must submit a post event evaluation form.
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