Changes

===Medical management===

===Medical management===

*Enemas to decrease the amount of bacteria in the colon.

*Enemas to decrease the amount of bacteria in the colon.

*Oral antibiotics such as ampicillin, neomycin or metronidazole can be given initially reduce the amount of bacteria in intestines and hence decrease the production of ammonia.

*Oral antibiotics such as [[Penicillins|ampicillin]], [[Aminoglycosides|neomycin]] or [[Nitroimidazoles|metronidazole]] can be given initially reduce the amount of bacteria in intestines and hence decrease the production of ammonia.

*Lactulose PO

*Lactulose PO

**This is a synthetic disaccharide which is metabolised by the acidifying colonic bacteria.  Ammonia is converted into ammonium ions, which cannot be absorbed and hence trapped in the colon and excreted in the faeces.  Lactulose also acts as an osmotic laxative, allowing more faeces and bacteria to be washed out.

**This is a synthetic disaccharide which is metabolised by the acidifying colonic bacteria.  Ammonia is converted into ammonium ions, which cannot be absorbed and hence trapped in the colon and excreted in the faeces.  [[Drugs Acting on the Intestines#Osmotic Laxatives|Lactulose]] also acts as an osmotic laxative, allowing more faeces and bacteria to be washed out.

*A high carbohydrate, low protein (2g/kg/day) and low fat diet is recommended.

*A high carbohydrate, low protein (2g/kg/day) and low fat diet is recommended.

**The aim is to provide adequate nutrients and energy to support hepatic tissue repair, reduce the metabolic load on the liver and minimise the development of hepatic encephalopathy

**The aim is to provide adequate nutrients and energy to support hepatic tissue [[Liver General Pathology - Pathology#Fibrosis - Repair|repair]], reduce the metabolic load on the liver and minimise the development of hepatic encephalopathy

==Prognosis==

==Prognosis==