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Encefalopatía hepática

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  • Overview
  • Theory
  • Diagnosis
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Last reviewed: 15 Nov 2025
Last updated: 06 Aug 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
  • alteraciones del estado de ánimo
  • alteraciones del sueño
  • alteraciones motoras
  • déficits neurológicos avanzados
Full details

Other diagnostic factors

  • asterixis
  • eritema palmar
  • angiomas aracniformes
  • edema periférico
  • ictericia
  • hepatomegalia
  • ascitis
Full details

Risk factors

  • hipovolemia
  • sangrado gastrointestinal
  • estreñimiento
  • consumo excesivo de proteínas
  • hipopotasemia
  • hiponatremia
  • alcalosis metabólica
  • hipoxia
  • uso de sedantes
  • uso de opioides
  • sobredosis de diuréticos
  • hipoglucemia
  • infección
  • trombosis de la vena porta o hepática
  • derivación portocava
  • insuficiencia renal
Full details

Diagnostic tests

1st tests to order

  • pruebas de función hepática
  • glucosa sérica
  • perfil de coagulación
  • electrolitos séricos
  • urea y creatinina
  • gasometría arterial (GSA) o gasometría venosa (GSV)
  • hemograma completo (HC)
  • marcadores de inflamación (p. ej. proteína C-reactiva)
  • hormona estimulante de la tiroides
  • nivel de alcohol en sangre
  • nivel de amoníaco en sangre
  • urocultivo
  • hemocultivo
  • cribado de toxinas en orina
  • ecografía
  • TC o IRM craneal
Full details

Tests to consider

  • electroencefalograma (EEG)
  • punción lumbar
  • paracentesis abdominal
Full details

Treatment algorithm

ACUTE

todos los pacientes

ONGOING

episodio previo/recurrente

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 and Central Virginia Veterans Healthcare System

Richmond

VA

Disclosures

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

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, RH, and MH 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.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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  • Calculators

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