Summary
Definition
History and exam
Key diagnostic factors
- mood disturbances
- sleep disturbances
- motor disturbances
- advanced neurologic deficits
Other diagnostic factors
- asterixis
- spider angiomata
- palmar erythema
- peripheral edema
- jaundice
- hepatomegaly
- ascites
Risk factors
- hypovolemia
- gastrointestinal bleeding
- constipation
- excessive protein intake
- hypokalemia
- hyponatremia
- metabolic alkalosis
- hypoxia
- sedative use
- hypoglycemia
- infection
- hepatic or portal vein thrombosis
- portacaval shunt
- renal impairment
Diagnostic investigations
1st investigations to order
- liver tests
- serum glucose
- coagulation profile
- serum electrolytes
- BUN and creatinine
- arterial or venous blood gas
- CBC
- urine culture
- blood culture
- urine toxin screen
- ultrasonography
- head CT scan
Investigations to consider
- EEG
- ammonia level
- lumbar puncture
- abdominal paracentesis
Treatment algorithm
all patients
previous/recurrent episode
Contributors
Authors
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
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.
Acknowledgements
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
Sammy Saab, MD, MPH, AGAF
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.
Jorge A. Marrero, MD
Assistant Professor of Medicine
Division of Gastroenterology
University of Michigan
Ann Arbor
MI
Disclosures
JAM declares that he has no competing interests.
Differentials
- Brain tumors
- Subdural hematoma
- Acute stroke
More DifferentialsGuidelines
- Hepatic encephalopathy in chronic liver disease
- Neuropsychological assessment of hepatic encephalopathy
More GuidelinesCalculators
MELDNa scores (for liver transplantation listing purposes, not appropriate for patients under age 12 years)
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