Resumen
Definición
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
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.
References
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.
Differentials
- Tumores cerebrais
- Hematoma subdural
- Acidente vascular cerebral (AVC) agudo
More DifferentialsGuidelines
- Clinical practice guidelines on the management of hepatic encephalopathy
- Acute-on-chronic liver failure clinical guidelines
More GuidelinesCalculators
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)
More Calculators
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer