Liver Disease pp 179-193 | Cite as

Hepatic Encephalopathy

  • Eric KallwitzEmail author
  • Zurabi Lominadze


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.


Cirrhosis 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 

Further Reading

  1. 1.
    Amodio P, Bemeur C, Butterworth R, Cordoba J, Kato A, Montagnese S, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International society for hepatic encephalopathy and nitrogen metabolism consensus. Hepatology. 2013;58(1):325–36. Scholar
  2. 2.
    Amodio P, Del Piccolo F, Petteno E, Mapelli D, Angeli P, Iemmolo R, et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol. 2001;35(1):37–45.CrossRefGoogle Scholar
  3. 3.
    Bajaj JS. The role of microbiota in hepatic encephalopathy. Gut Microbes. 2014;5(3):397–403. Scholar
  4. 4.
    Bajaj JS, Schubert CM, Heuman DM, Wade JB, Gibson DP, Topaz A, et al. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Gastroenterology. 2010;138(7):2332–40. Scholar
  5. 5.
    Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med. 2010;362(12):1071–81. Scholar
  6. 6.
    Blei AT, Cordoba J. Hepatic encephalopathy. Am J Gastroenterol. 2001;96(7):1968–76. Scholar
  7. 7.
    Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716–21. Scholar
  8. 8.
    Garcia-Martinez R, Rovira A, Alonso J, Jacas C, Simon-Talero M, Chavarria L, et al. Hepatic encephalopathy is associated with posttransplant cognitive function and brain volume. Liver Transpl. 2011;17(1):38–46. Scholar
  9. 9.
    Jones EA, Mullen KD. Theories of the pathogenesis of hepatic encephalopathy. Clin Liver Dis. 2012;16(1):7–26. Scholar
  10. 10.
    Ortiz M, Jacas C, Cordoba J. Minimal hepatic encephalopathy: diagnosis, clinical significance and recommendations. J Hepatol. 2005;42(Suppl 1):S45–53. Scholar
  11. 11.
    Saab S, Suraweera D, Au J, Saab EG, Alper TS, Tong MJ. Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials. Liver Int. 2016;36(7):986–93. Scholar
  12. 12.
    Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, 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;60(2):715–35. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Hepatology, Department of MedicineLoyola University Chicago Stritch School of MedicineMaywoodUSA
  2. 2.Division of Gastroenterology and Nutrition, Department of MedicineLoyola University Chicago Stritch School of MedicineMaywoodUSA

Personalised recommendations