Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- distúrbios do humor
- perturbações do sono
- distúrbios motores
- deficit neurológico avançado
Other diagnostic factors
- asterixis (flapping)
- eritema palmar
- aranhas vasculares
- edema periférico
- icterícia
- hepatomegalia
- ascite
Risk factors
- hipovolemia
- hemorragia digestiva
- constipação
- ingestão excessiva de proteína
- hipocalemia
- hiponatremia
- alcalose metabólica
- hipóxia
- uso de sedativos
- uso de opioides
- superdosagem de diuréticos
- hipoglicemia
- infecção
- trombose da veia porta ou hepática
- anastomose porto-cava
- comprometimento renal
Diagnostic tests
1st tests to order
- testes da função hepática
- glicose sérica
- perfil de coagulação
- eletrólitos séricos
- ureia e creatinina
- gasometria arterial ou venosa
- Hemograma completo
- marcadores inflamatórios (por exemplo, proteína C-reativa)
- hormônio estimulante da tireoide
- nível de álcool no sangue
- nível de amônia sanguíneo
- urocultura
- hemocultura
- rastreamento de toxina na urina
- ultrassonografia
- TC ou RNM do crânio
Tests to consider
- eletroencefalograma (EEG)
- punção lombar
- paracentese abdominal
Treatment algorithm
todos os pacientes
episódio prévio/recorrente
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
Divulgaciones
JB’s institution has received research support from Bausch, Grifols, Cosmo, and Sequana.
Agradecimientos
Dr Jasmohan Bajaj would like to gratefully acknowledge Dr Emily Speelmon, Dr Robert Hyzy, and Dr Meilan Han, previous contributors to this topic.
Divulgaciones
ES, RH, and MH declare that they have no competing interests.
Revisores por pares
Sammy Saab, MD, MPH, AGAF
Professor of Medicine
Department of Internal Medicine and Surgery
David Geffen School of Medicine
UCLA
Los Angeles
CA
Divulgaciones
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
Divulgaciones
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.
Referencias
Artículos principales
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 Resumen
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 Resumen
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 Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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Más DiferencialesGuías de práctica clínica
- Clinical practice guidelines on the management of hepatic encephalopathy
- Acute-on-chronic liver failure clinical guidelines
Más Guías de práctica clínicaCalculadoras
Escore MELDNa (para fins de listagem de transplantes de fígado, não é adequado para pacientes com menos de 12 anos de idade ) (unidades SI)
Classificação de Child-Pugh para gravidade da doença hepática (unidades SI)
Más Calculadoras
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