Last reviewed: November 2017
Last updated: December  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • mood disturbances
  • sleep disturbances
  • motor disturbances
  • advanced neurological deficits

Other diagnostic factors

  • palmar erythema
  • spider angiomata
  • peripheral oedema
  • jaundice
  • hepatomegaly
  • ascites
  • hemiplegia

Risk factors

  • cirrhosis
  • hypovolaemia
  • gastrointestinal bleeding
  • hypokalaemia
  • metabolic alkalosis
  • hypoxia
  • sedative use
  • hypoglycaemia
  • infection
  • hepatic or portal vein thrombosis
  • acute hepatic failure
  • portacaval shunt

Diagnostic investigations

1st investigations to order

  • LFTs
  • serum glucose
  • coagulation profile
  • urine culture
  • blood culture
  • urine toxin screen
  • ultrasonography
  • psychometric tests
  • head CT scan
Full details

Investigations to consider

  • EEG
  • ammonia level
  • lumbar puncture
  • abdominal paracentesis
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Affiliate Assistant Professor, Pulmonary and Critical Care Medicine

Department of Medicine

Oregon Health and Science University School of Medicine

Portland

OR

Disclosures

ES declares that she has no competing interests.

Dr Emily Speelmon would like to gratefully acknowledge Dr Robert Hyzy and Dr Meilan Han, previous contributors to this monograph. MH and RH declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Division of Gastroenterology

University of Michigan

Ann Arbor

MI

Disclosures

JAM declares that he has no competing interests.

Use of this content is subject to our disclaimer