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Hepatic encephalopathy

Last reviewed: 7 Aug 2025
Last updated: 06 Aug 2024

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • mood disturbances
  • sleep disturbances
  • motor disturbances
  • advanced neurologic deficits
Detalhes completos

Outros fatores diagnósticos

  • asterixis
  • spider angiomata
  • palmar erythema
  • peripheral edema
  • jaundice
  • hepatomegaly
  • ascites
Detalhes completos

Fatores de risco

  • hypovolemia
  • gastrointestinal bleeding
  • constipation
  • excessive protein intake
  • hypokalemia
  • hyponatremia
  • metabolic alkalosis
  • hypoxia
  • sedative use
  • opioid use
  • diuretic overdose
  • hypoglycemia
  • infection
  • hepatic or portal vein thrombosis
  • portacaval shunt
  • renal impairment
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • liver function tests
  • serum glucose
  • coagulation profile
  • serum electrolytes
  • BUN and creatinine
  • arterial or venous blood gas
  • CBC
  • inflammatory markers (e.g., CRP)
  • thyroid-stimulating hormone
  • blood alcohol level
  • blood ammonia level
  • urine culture
  • blood culture
  • urine toxin screen
  • ultrasonography
  • head CT or MRI scan
Detalhes completos

Investigações a serem consideradas

  • EEG
  • lumbar puncture
  • abdominal paracentesis
Detalhes completos

Algoritmo de tratamento

AGUDA

all patients

CONTÍNUA

previous/recurrent episode

Colaboradores

Autores

Jasmohan S. Bajaj, MD, FAASLD, FACG, AGAF, FRCP (London), MS

Professor of Medicine

Department of Internal Medicine

Division of Gastroenterology, Hepatology and Nutrition

Virginia Commonwealth University and Central Virginia Veterans Healthcare System

Richmond

VA

Declarações

JB’s institution has received research support from Bausch, Grifols, Cosmo, and Sequana.

Agradecimentos

Dr Jasmohan Bajaj would like to gratefully acknowledge Dr Emily Speelmon, Dr Robert Hyzy, and Dr Meilan Han, previous contributors to this topic.

Declarações

ES, RH, and MH declare that they have no competing interests.

Revisores

Sammy Saab, MD, MPH, AGAF

Professor of Medicine

Department of Internal Medicine and Surgery

David Geffen School of Medicine

UCLA

Los Angeles

CA

Declarações

SS is a member of the speaker bureau and advisory board for Salix.

Jorge A. Marrero, MD

Assistant Professor of Medicine

Division of Gastroenterology

University of Michigan

Ann Arbor

MI

Declarações

JAM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014 Aug;60(2):715-35.Texto completo  Resumo

European Association for the Study of the Liver. EASL clinical practice guidelines on the management of hepatic encephalopathy. J Hepatol. 2022 Sep;77(3):807-24.Texto completo  Resumo

Bajaj JS, O'Leary JG, Lai JC, et al. Acute-on-chronic liver failure clinical guidelines. Am J Gastroenterol. 2022 Feb 1;117(2):225-52.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Diagnósticos diferenciais

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  • Diretrizes

    • Acute-on-chronic liver failure clinical guidelines
    • Clinical practice guidelines on the management of hepatic encephalopathy
    Mais Diretrizes
  • Calculadoras

    Child Pugh classification for severity of liver disease

    MELDNa scores (for liver transplantation listing purposes, not appropriate for patients under age 12 years)

    Mais Calculadoras
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