Hepatic encephalopathy grading mnemonic

Hepatic Encephalopathy Mnemonic: - Medical information

Hepatic Encephalopathy Mnemonic: HEPATICUS * Haemorrhage, * Electrolye imbalance (↓K+ alkalosis), * protein XS (↑NH4+ XS), * Alcohol/ Analgesics, *.. Stage Mental Status Asterixis EEG Stage1 Changes in behavior (euphoria/depression), mild confusion, slurred speech, disordered sleep Yes/No Usually Normal Stage 2 Lethargy, moderate confusion Yes MELD (Model For End Stage Liver Disease) Score. Model for End-Stage Liver Disease (MELD) is a numerical scale, ranging from 6 (less ill) to 40 (gravely ill), used for liver transplant candidates age 12 and older. It gives each person a 'score' (number) based on how urgently he or she needs a liver transplant within the next three months overt hepatic encephalopathy; it grades the severity of the hepatic encephalopathy based on a clinical assessment, with a score ranging from grade 0 (no abnormalities) to grade 4 (coma) (Figure 3). [9,10] The Glasgow Coma Scale, however, may be more useful in persons with severe encephalopathy and a marke

Staging or Grading Hepatic Encephalopathy Time of Car

Child Pugh Score: Mnemonic and Explanation Epomedicin

Diagnosis and Management of Hepatic Encephalopathy - Core

  1. ology. Hepatic encephalopathy (HE) specifically refers to an encephalopathy occurring in patients with acute liver failure, a portosystemic shunt, or chronic liver disease.HE is generally regarded as a reversible condition, although the long-term sequelae are being further studied 11.. Hepatic encephalopathy may be subclassified according to severity and pattern (acute episode, recurrent.
  2. imal that they may not be outwardly noticeable, even to you
  3. Hepatic encephalopathy (HE) is an altered level of consciousness as a result of liver failure. Its onset may be gradual or sudden. Other symptoms may include movement problems, changes in mood, or changes in personality. In the advanced stages it can result in a coma.. Hepatic encephalopathy can occur in those with acute or chronic liver disease. Episodes can be triggered by infections, GI.
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  5. Loss of brain function occurs when the liver is unable to remove toxins from the blood. This is called hepatic encephalopathy (HE). This problem may occur suddenly or it may develop slowly over time

Sepsis-associated encephalopathy (SAE) is defined as diffuse cerebral dysfunction that accompanies sepsis in the absence of direct CNS infection, structural abnormalities, or other types of encephalopathy. 273 Delirium is the most common clinical manifestation, occurring in 30% to 50% of patients with severe sepsis Refining the ammonia hypothesis: A physiology-driven approach to the treatment of hepatic encephalopathy. Mayo Clin Proc. 2015;90:646-658. PubMed 2. Parekh PJ, Balart LA. Ammonia and Its Role in the Pathogenesis of Hepatic Encephalopathy. Clin Liver Dis. 2015;19:529-537. PubMed 3. Blei AT, Córdoba J. Hepatic Encephalopathy

Hepatic Encephalopathy - clevelandclinicmeded

Hepatic Encephalopathy: Types, Causes, Symptoms, Treatmen

Encephalopathy — Hepatic encephalopathy is linked to an increase in caregiver burden , and it affects decision-making capacity. When a patient suffers from hepatic encephalopathy, it is especially important to carry out ACP during a period when he or she is lucid and to document evidence of decision-making capacity at the time of completion. The Child-Pugh score is a system for assessing the prognosis of chronic liver disease and cirrhosis. It can be used to determine the required treatment and need for liver transplant. This article. Hepatic Encephalopathy. Hepatic encephalopathy is a reversible condition in which elevated ammonia levels cause impaired brain function in patients with advanced liver disease. Hepatic encephalopathy can be precipitated by conditions that affect the normal absorption, metabolism, or clearance of ammonia, including dehydration, renal failure. A Mnemonic for Differential Diagnosis of Altered Mental Status 5 Hepatic encephalopathy is a brain dysfunction caused by liver Hepatic Encephalopathy -Grading Grade Features 0 No abnormalities detected 1 Unawareness (mild), euphoria or anxiety, shortened attentio Grading of Hepatic Encephalopathy Grade Description 0 Normal mental status. Asterixis absent. 1 Mild confusion. Asterixis can be detected. 2 Lethargy with inappropriate behavior. Obvious asterixis. 3 Somnolent with incomprehensible speech and marked confusion 4 Coma Adapted with permission from Blei AT, Cordoba J. Hepatic enceph-alopathy

Fulminant Hepatic Failure • LITFL • CCC Toxicolog

  1. Here, we aimed to present a simple and handy mnemonic acronym for selecting resectable HCCs in surgical practice. This was reproduced from the existing well-known staging systems. The designed mnemonic acronym is a phrase PERISH and it includes asking for Performance of patient, Extra-hepatic disease, Reserve of liver, Intra-hepatic.
  2. 23 April 2018, at 9:24pm. Hepatic encephalopathy (HE) is described as a spectrum of neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of other known brain disease (Ferenci et al., 2002). HE is most frequently found in association with some form of portosystemic shunt (PSS) in dogs and cats but may also occur.
  3. Mnemonic: Head CMI (head = hepatic encephalopathy + ICH) 1. Hepatic encephalopathy 2. Intracranial Hypertension 3. Coagulopathy 4. Metabolic - low glucose, potassium, sodium; metabolic acidosis 5. Infectio
  4. Hepatic encephalopathy should be suspected in patients with alcoholism, presentation c/w cirrhosis, or known cirrhosis. Signs and symptoms include sleep disturbance, euphoria, asterixis, slurred speech, disorientation, slurred speech, inappropriate behavior, nystagmus, confusion, and somnolence (Khungar, 2012)
  5. Seven states (designated by the mnemonic WHHHIMP ) require prompt intervention to avoid death or permanent CNS damage: Wernicke's encephalopathy, hypoxia, hypoglycemia, hypertensive encephalopathy, intracerebral hemorrhage, meningitis/encephalitis, and poisoning, whether exogenous or iatrogenic. Other conditions requiring prompt intervention.
  6. lactic acidosis can occur due to: (i) excessive tissue lactate production (ii) impaired hepatic metabolism of lactate (large capacity to clear) clinically there is often a combination of the above to produce a persistent lactic acidosis. CAUSES (Cohen & Woods classification) Type A - Inadequate Oxygen Delivery

Special Considerations in Interpreting Liver Function

Decompensated liver disease and cirrhosis are common pathological states present on the gastroenterology ward. It is important to understand the basic principles of management and aetiology as a junior doctor in these complex and unwell patients. Dr Liz Sweeney is a specialist hepatology registrar at the Royal Liverpool Hospital. In this episode, she talks t 3. Definition Hepatic encephalopathy (HE) is a complex metabolic mental state disorder with a spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with severe acute or chronic liver dysfunction after exclusion of other brain diseases. 4 The rate of hepatic encephalopathy was high in most of these studies at more than 35%.2 114 116-118 The study by Lv et al showed lower mortality (12% vs 26%) and hepatic encephalopathy (32% vs 14%) in the INCPH group compared with cirrhotic patients.119 Ascites, malignancy, immunological disorders and female sex were associated with mortality. The severity of liver disease was assessed in each patient based on five clinical features: 1) total bilirubin level, 2) serum albumin, 3) prothrombin time (now measured as the INR), 4) the degree of ascites, and 5) the grade of hepatic encephalopathy. The total point score was then used to determine the patient's Child-Pugh class

King's College Criteria for Acetaminophen Toxicity. Recommends who should be immediately referred for liver transplant. The KCC are a well-accepted criteria that show the degree of multiorgan dysfunction from acetaminophen-induced liver failure. Used alone or with serum lactate and phosphate, the KCC can predict patients with poor prognosis Changes in behavior and level of consciousness are the first sins of hepatic encephalopathy. Hepatic encephalopathy is caused by liver failure and develops when the liver is unable to convert protein metabolic product ammonia to urea. This results in accumulation of ammonia and other toxic in the blood that damages the cells 3 methods of determining caloric intake. Empiric - 25-35kcal/kg/day. Equations - Harris/Benedict, Scofield. Indirect calorimetry -Weir equation. neurology. Advantages of the GCS. Widely recognised. Quick and reproducible. Skewed towards motor score- which is most reliable and most useful clinical indicator of severity of TBI

In addition, these authors claim that doctors sometimes use the mnemonic device AEIOU-TIPS to recall portions of the differential diagnosis: Alcohol ingestion and acidosis, Epilepsy and encephalopathy, were able to correctly diagnose hepatic encephalopathy grades 2 and higher compared with grade 1 or no hepatic encephalopathy.. The Child-Pugh Score can be useful in the prognosis of patients with cirrhosis, but more recent scores like the MELD score and MELD-Na have become more used given their better prognostic value. Bilirubin (Total) <2 mg/dL (<34.2 µmol/L) +1. 2-3 mg/dL (34.2-51.3 µmol/L) +2. >3 mg/dL (>51.3 µmol/L) +3. Albumin CNS: hepatic encephalopathy is the decrease in conscious level seen in association with severe liver disease. In the early stages a reversal of the sleep-wake cycle is seen with patients sleeping during the day. As encephalopathy advances, subtle changes in intellectual function occur with confusion, memory loss and irritability being common Patients with minimal hepatic encephalopathy (MHE) show mild cognitive impairment associated with alterations in attentional and executive networks. tumour staging and the biological grading.


Hepatic Encephalopathy Posterior Reversible Encephalopathy Syndrome Radiation-induced brain edema Post-surgical changes Amyloid Wijdicks, Eelco F. M. (2016-10-27). Hepatic Encephalopathy.The New England Journal of Medicine. 375 (17): 1660-1670. doi: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical disease characterized by cerebral edema Case of 5 months Infant with Fulminant Hepatic Failure. Editor January 9, 2014. A 5 moths Male was brought with complains of. Yellowish discoloration of eyes and body for 15 days. Excessive crying for 2 days. Decrease responsiveness for 1 day. Causes of acute liver failure In Adults Overall hepatic function can be assessed by applying the values for albumin, bilirubin and prothrombin time in the modified Child-Turcotte grading system. The commonly used liver function tests (LFTs) primarily assess liver injury rather than hepatic function

Sepsis-associated encephalopathy (SAE) is a clinical syndrome that is associated with diffuse brain dysfunction and is secondary to infection in the body. Severity of SAE ranges from mild delirium. - MOA: decreases hepatic glucose output, increases insulin sensitivity and decreases intestinal glucose absorption. - A1C decrease 1 - 1.5% - take with food to minimize D/N and farts - BBW: lactic acidosis - Warnings: - do not start if eGFR < 45 - can cause vitamin B12 deficiency - stop prior to iodinated contrast - CI: eGFR < 3 Liver failure can be either acute (comes on quickly) or chronic (occurs gradually over time). Damage to your liver builds up over stages, affecting your liver's ability to function. Learn more.

The second situation is when the patient has Fulminant hepatic failure. Fulminant hepatic failure by definition is severe acute liver disease with any level of hepatic encephalopathy. And if that's the case, then these patients should be referred to, they are then admitted to a tertiary care center where they do liver transplants Acute liver failure (ALF) is an uncommon condition in which rapid deterioration of liver function results in coagulopathy and alteration in the mental status of a previously healthy individual. Acute liver failure often affects young people and carries a very high mortality Aetiology - in the UK, paracetamol (acetaminophen) overdose is the most common cause (70%) of ALF, but worldwide it is viral hepatitis (Figure 1). Figure 1: Causes of acute liver failure Pathology - there is centrilobular necrosis of hepatocytes with activation of macrophages and liberation of cytokines, specifically tumour necrosis factor and interleukins 1 and 6

The basics: Osteomyelitis. Osteomyelitis is an infectious disease that attacks the bones, specifically the bone marrow. It can have several etiologies: infection from an open fracture, postoperative infection, spread of a blood-borne infection such as pharyngitis, otitis etc Transfusion of blood contaminated with bacteria. 2. Volume overload (hypervolemia) 3. Iron overload due to multiple transfusions. 4. Bleeding and electrolyte changes: Massive transfusion of stored blood may cause bleeding and electrolyte changes. 5

Acute liver failure (ALF) results from an abrupt loss of hepatic metabolic and synthetic function and leads to encephalopathy and potentially multi-organ dysfunction. Aetiologies include autoimmune and metabolic diseases, infectious agents and hepatotoxins. Worldwide, infectious hepatitis (A, B and E) is the most common cause Most patients die of gastrointestinal bleeding, hepatic encephalopathy, or sepsis. Patients with abetalipoproteinemia develop functional deterioration early in life and do not survive beyond the third decade. Chorea-acanthocytosis syndrome is an irreversible entity with a slow, unrelenting progression of symptoms to death over 8-14 years.. 107. 3 diagnostic categories of jaundice / Conditions that favor neurotoxicity in hyperbilirubinemia / Progression of hepatic encephalopathy 108. Ancillary testing in jaundice 109. Dangerous causes of pelvic pain in nonpregnant or 1st trimester 110. Nonemergent causes of pelvic pain / Ancillary tests to consider 111 Portal hypertension refers to a pathological elevation of portal venous pressure resulting from obstructions in portal blood flow, which may be either prehepatic (e.g., portal vein thrombosis), hepatic (e.g., liver cirrhosis), or posthepatic (e.g., right-sided heart failure) Exam was notable for scleral icterus, RUQ tenderness to palpation with associated distention, and without focal neuro deficits. There was also robust discussion surrounding checking for asterixis since hepatic encephalopathy was surely on the differential given a past medical history of NASH cirrhosis and a liver transplant candidate. Dr

Minimal Hepatic Encephalopathy: Silent Tragedy | IntechOpen

Child-Pugh score - Wikipedi

Quang Bui - Rifaximin and Hepatic Encephalopathy FINAL - Free download as Powerpoint Presentation (.ppt), PDF File (.pdf) or view presentation slides online. Presentation about hepatic encephalopathy. Emphasis on rifaximin and its uses in hepatic encephalopathy Hypocalcemia is a total serum calcium concentration < 8.8 mg/dL (< 2.20 mmol/L) in the presence of normal plasma protein concentrations or a serum ionized calcium concentration < 4.7 mg/dL (< 1.17 mmol/L). Causes include hypoparathyroidism, vitamin D deficiency, and renal disease. Manifestations include paresthesias, tetany, and, when severe, seizures, encephalopathy, and heart failure In the centre of each segment there is a branch of the portal vein, hepatic artery and bile duct. In the periphery of each segment there is vascular outflow through the hepatic veins. Right hepatic vein divides the right lobe into anterior and posterior segments. Middle hepatic vein divides the liver into right and left lobes. It runs from the. The eMedicine point-of-care clinical reference features up-to-date, searchable, peer-reviewed medical articles organized in specialty-focused textbooks, and is continuously updated with practice-changing evidence culled daily from the medical literature

Hepatic encephalopathy Radiology Reference Article

Grades of Hepatic Encephalopathy - West Haven Criteria • Grade 1 - Inattention, euphoria/anxiety, altered sleep pattern, ↓ attention span • Grade 2 - Lethargy, behavior Δs, time disorientation, asterixis, personality Δs, hypoactive DTRs • Grade 3 - Somnolence to semistupor, responsive to stimuli, time & place disorientation, asterixis, hyperactive DTRs • Grade 4 - Coma #WestHaven #. Acute Hepatic Encephalopathy 2/2 to _____ Symptoms caused by a failure of liver to detoxify NH3 and other substances that cause cerebral edema and/or act as false neurotransmitters (GABA-like) Precipitating causes evaluated. PE: Asterixis present? Pt has hepatic encephalopathy stage___

Hepatic Encephalopathy Symptoms & Diagnosing HE - AL

- Mnemonic: ‣ M etabolic ‣ E endocrine ‣ D etox/metab drugs ‣ I mmune ‣ C oag ‣ A cid/base ‣ B ile formation ‣ R eservoir for blood ‣ U rea formation ‣ S torage function ‣ H aematopoesis By Disease Acute Hepatic Disease - = development of hepatocelluar dysfunction assoc with coagulopathy & encephalopathy in pts without prio The video below demonstrates persistent vertical and horizontal nystagmus in a patient with Wernicke encephalopathy - which results from acute thiamine (vitamin B1) deficiency. In order to make the diagnosis, two of the following four symptoms and/or findings must be present: confusion, ataxia, ophthalmoplegia and nutritional depletion 28. Hepatic encephalopathy 29. Acute Cholecystitis 30. G6PD deficiency 31. Constipation, hypercalcemia, primary hyperparathyroidism 32. Pregnancy with asymptomatic bactiriuria 33. Back pain due to osteoporotic fracture - compression fracture 34. Bipolar disorder 35. Plulmonary embolism 36

Hepatic encephalopathy - Wikipedi

Severity of liver disease was calculated according to the Child-Pugh score with grades A (mild) to C (severe) indicating degree of hepatic reserve and function . Nutritional Assessment. Nutritional assessment was based on the following: anthropometry, visceral proteins, lean body mass and subjective global assessment (SGA) Very useful mnemonics. Aphthous ulcers, Pyoderma gangrenosum, Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, clubbing. Which I. B. D. has C-obblestones on endoscopy - C-rohn's. If QRS complex is wide, consider bundle branch block. LBBB causes a W pattern in V1-2 and a M pattern in V5-6 Hepatic. Cirrhosis causes jaundice, ascites, hepatomegaly, edema of the legs, hepatic encephalopathy, and hepatic renal syndrome. Complications. The complications of hepatic cirrhosis include the following: Portal hypertension. Portal hypertension is the elevation of pressure in the portal vein that occurs when blood flow meets increased. Altered mental status (AMS) is not a disease: it is a symptom. Causes run the gamut from easily reversible (hypoglycemia) to permanent (intracranial hemorrhage) and from the relatively benign (alcohol intoxication) to life threatening (meningitis or encephalitis). The differential diagnoses are enormous November 5, 2013. November 5, 2013 jneuro. General medicine, Neurology coma, encephalopathy, Intensive Care. The pathophysiology of hepatic encephalopathy is complex and not really well understood. We use the case of a neuro consult for an obtunded hepatic failure patient to discuss the various (mostly hypothetical) components

5. Als-Nielsen B, Kjaergard LL, Gluud C. Benzodiazepine receptor antagonists for acute and chronic hepatic encephalopathy. Cochrane Database Syst Rev 2001; :CD002798. 6. Goulenok C, Bernard B, Cadranel JF, et al. Flumazenil vs. placebo in hepatic encephalopathy in patients with cirrhosis: a meta-analysis. Aliment Pharmacol Ther 2002; 16:361 A) hepatic blood flow B) induction state of hepatic enzymes C) hepatic disease. Question # 2 (True/False) In rheumatoid arthritis patients, increased alpha1-acidic glycoprotein may be associated with increased lidocaine protein binding. A) true B) false. Question # 3 (Multiple Choice) Hepatic flow-dependent drug elimination refers to Criteria & classifications A Agatson score : CAD Austin - kartush classification - middle ear risk index ( MERI) Alanzolej classification : chloledochal cyst Amsel's criteria: bacterial vaginosis Ann Arbours staging: Hodgkin's lymphoma & Non Hodgkin's lymphoma Ashbury criteria : GBS Astler collar:colorectal cancer B Belthazar scoring : acute pancreatitis Bent criteria : allergic funga

Primary Care Notebook's content database was originally started while the core authors were medical students in the 1990s, and it became a reflection of our learning and knowledge as we progressed through medical school and into our working lives. Today, the site is used by tens of thousands of primary care professionals across the world. Since most cases of intoxication involve episodes of altered mental status, a helpful mnemonic for the emergency room physician is the following: A - alcohol E - encephalopathy (hypertensive, hepatic), electrolytes, endocrine, environmenta In the context of UGIB, a patient's consciousness level may be reduced secondary to hypotension or hepatic encephalopathy. Assess the patient's level of consciousness using the AVPU scale : A lert: the patient is fully alert, although not necessarily orientated A useful mnemonic to ensure that all aspects of a person's life are considered during the consultation is the for five days * to prevent the onset of Wernicke's encephalopathy caused by a thiamine deficiency due to a poor diet and/or Contraindications to disulfiram include severe hepatic or renal impairment. 1. affective 2. mnemonic 3. hallucinatory 4. illusory. this is a sensory aura and is defined as phenomena including tingling, numbness, electric-shock like sensation, pain, sense of movement, or desire to move. Somatosensory aura occur in seizures involving the____. somatosensory, sensorimotor cortex

Hepatic Encephalopathy (Hepatic Coma) | Nurse, Medical

Definitions of 'severe organ system insufficiency' and 'immunocompromised' Liver: Biopsy-proven cirrhosis with portal hypertension; episodes of past upper GI bleeding attributed to portal hypertension; or prior episodes of of hepatic failure, encephalopathy, or coma; Cardiovascular: New York Heart Association (NYHA) class IV heart failure; Respiratory: Chronic restrictive, obstructive, or. Persistently yellow urine staining the nappy can be a sign of liver disease. Symptoms of ibs include alternating bouts of constipation and diarrhea abdominal pain and a frequent sudden and urgent need to pass bowel movements

Introduction. Liver function tests (LFTs) are among the most commonly ordered blood tests in both primary and secondary care. The ability to interpret LFTs is, therefore, an important skill to develop. This guide provides a structured approach to the interpretation of LFTs which you should be able to apply in most circumstances Digital clubbing is an ancient and important clinical signs in medicine. Although clubbed fingers are mostly asymptomatic, it often predicts the presence of some dreaded underlying diseases. Its exact pathogenesis is not known, but platelet-derived growth factor and vascular endothelial growth. 3 layers of fascia, 1 muscle. transversalis fascia (int spermatic fascia), cremaster m and fascia (int oblique), int and ext oblique fascia (ext spermatic) contents of femoral triangle. to find your NAVEL, go lateral to medial. nerve artery vein empty lymph. indirect vs direct hernia - mnemonic. MDs dont LIe Pharmacology is a very important subject for every Medical, Pharmacy, and Nursing student. We have shared more than 100 Pharmacology Facts which will help every student to study and remember Pharmacology in a simple way.These pharmacology facts contains classification, mechanism of action, side effect, drug interaction of various drugs Neonatal liver failure can be defined as failure* of the synthetic function of liver within 4 weeks of birth. Encephalopathy is not essential for the diagnosis. *Uncorrectable coagulopathy with INR >1.5 in patients with hepatic encephalopathy, or INR> 2.0 in patients without encephalopathy. 10

HEPATIC ENCEPHALOPATHY: Flapping tremors: HODGKIN'S DSE/LYMPHOMA: painless, progressive enlargement of spleen & lymph tissues, Reedstenberg Cells: HYDROCEPHALUS: Bossing sign (prominent forehead) HYPERTHYROIDISM/GRAVE'S DISEASE: exopthalmus: HYPOCALCEMIA: Chvostek & Trosseaus sign: INCREASE ICP: HYPERtension BRADYpnea BRADYcardia (Cushing. Inflammatory changes lead to seizures, headache and encephalopathy. Coma may develop due to widespread oedema and raised ICP. Look for vasculitis rashes, eyes for inflammatory changes, retina and even perineum for ulceration. Renal urine analysis to exclude a glomerulonephritis. Investigations. FBC: WCC, DWCC, CRP, ESR and abnormal LFTs, U&E. The all-in-one Classroom and NCLEX. Supplement for future nurses. From pre-nursing to NCLEX® success, NURSING.com provides clear and concise study tools for visual, anxious, ADHD, and dyslexic future nurses. Trusted by over 360,000+ future nurses

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RIGHT UPPER QUADRANT abdominal pain differential diagnosis: Biliary and hepatic etiologies cause right upper quadrant pain syndromes. — Biliary colic - also known as a gallbladder attack, is when pain occurs due to a gallstone temporarily blocking the bile duct.Symptoms include an intense, dull discomfort located in the right upper quadrant, that may radiate to the back (particularly the. U.S. Phone: 1-800-222-1222. Consider Coma cocktail (consider for unknown drug ingestion with Altered Level of Consciousness) Dextrose 25% to 50% (for Hypoglycemia demonstrated by Glucometer) Naloxone 0.4-2 mg IV (for possible Narcotic Overdose) Other agents to consider Blueprints Psychiatry, 5th Edition.pd ATI offers reporting of TEAS (Test of Essential Academic Skills) test results to schools as a convenience to nursing school applicants. However, it is solely your responsibility to ensure that each of your school applications, as well as your TEAS test results, is complete, properly submitted, and on file with each such school