Resumo
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
Other diagnostic factors
- asterixis
- eritema palmar
- angiomas aracniformes
- edema periférico
- ictericia
- hepatomegalia
- ascitis
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
Diagnostic investigations
1st investigations 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
Investigations to consider
- electroencefalograma (EEG)
- punción lumbar
- paracentesis abdominal
Treatment algorithm
todos los pacientes
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.
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
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.
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