Hepatic encephalopathy (HE) describes the alteration in brain function that occurs in the setting of advanced liver dysfunction or shunting of blood from the portal to systemic circulation. As such, it represents one of the complications of cirrhosis and portal hypertension. HE can manifest as either subclinical (minimal HE) or overt clinical disease, ranging from mild cognitive impairment to coma. The lifetime risk of overt HE in a cirrhotic patient approaches 30–40%. The presence of HE often has a significant impact on the quality of life of patients and their caregivers, frequently resulting in repeated hospitalizations. Symptoms of liver dysfunction, such as HE, are important as these events signify hepatic decompensation. The degree of HE is incorporated into the Child-Pugh classification of severity of liver disease. However, HE is not a part of the Model for End-Stage Liver Disease (MELD) scoring system , which is now the most common and accepted method to assess severity of liver disease. This chapter will focus on the diagnosis and management of HE in the setting of cirrhosis.
KeywordsCirrhosis Portal hypertension Liver dysfunction Circulatory dysfunction Asterixis Acute liver failure Chronic liver disease Portosystemic shunting Glasgow Coma Scale Lactulose Neomycin Metronidazole End-stage liver disease
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