Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- mood disturbances
- sleep disturbances
- motor disturbances
- advanced neurological deficits
Other diagnostic factors
- asterixis
- palmar erythema
- spider angiomata
- peripheral oedema
- jaundice
- hepatomegaly
- ascites
Risk factors
- hypovolaemia
- gastrointestinal bleeding
- constipation
- excessive protein intake
- hypokalaemia
- hyponatraemia
- metabolic alkalosis
- hypoxia
- sedative use
- hypoglycaemia
- infection
- hepatic or portal vein thrombosis
- portacaval shunt
- renal impairment
Diagnostic investigations
1st investigations to order
- liver tests
- serum glucose
- coagulation profile
- serum electrolytes
- urea and creatinine
- arterial or venous blood gas
- FBC
- urine culture
- blood culture
- urine toxin screen
- ultrasonography
- head CT scan
Investigations to consider
- EEG
- ammonia level
- lumbar puncture
- abdominal paracentesis
Treatment algorithm
Contributors
Authors
Professor of Medicine
Department of Internal Medicine
Division of Gastroenterology, Hepatology and Nutrition
Virginia Commonwealth University
Richmond
VA
Disclosures
JB’s institution has received funding for research from Valeant Mallinckrodt and Grifols. JB has been on advisory boards for Valeant, Mallinckrodt, and Norgine.
Dr Jasmohan Bajaj would like to gratefully acknowledge Dr Emily Speelmon, Dr Robert Hyzy, and Dr Meilan Han, previous contributors to this topic.
Disclosures
ES, MH, and RH declare that they have no competing interests.
Peer reviewers
Professor of Medicine
Department of Internal Medicine and Surgery
David Geffen School of Medicine
UCLA
Los Angeles
CA
Disclosures
SS is a member of the speaker bureau and advisory board for Salix.
Assistant Professor of Medicine
Division of Gastroenterology
University of Michigan
Ann Arbor
MI
Disclosures
JAM declares that he has no competing interests.
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