Hepatic encephalopathy

A neuropsychiatric syndrome caused by acute or chronic hepatic insufficiency.

Symptoms vary in severity from a mild alteration in mental state to coma but are often reversible with treatment.

Causation is thought to be multi-factorial, resulting in brain exposure to ammonia that has bypassed the liver through portosystemic shunting.

Diagnosis is based on reported neurological deficits combined with laboratory abnormalities showing severe liver dysfunction.

Treatment approaches include providing supportive care (such as preventing aspiration), correcting precipitating factors, and reducing gastrointestinal production of ammonia.

Hepatic encephalopathy (HE) is a brain dysfunction caused by liver insufficiency and/or portosystemic shunt. It manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma.[1]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. https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.27210 http://www.ncbi.nlm.nih.gov/pubmed/25042402?tool=bestpractice.com

This topic discusses HE in patients with cirrhosis. For a discussion of HE in acute liver failure, see our Acute liver failure topic.