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Portosystemic Encephalopathy

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Liver Disorders

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Abstract

Hepatic encephalopathy (HE) is a well known complication of liver cirrhosis, which is manifested by a spectrum of neuro-psychiatric signs and symptoms. HE usually along with variceal bleeding and ascites declares decompensated phase of cirrhosis. While as the overt HE (OHE) may be readily apparent clinically, the covert HE (CHE), which includes minimal HE (MHE) and Grade I HE, needs specialized psychometric testing for diagnosis. There is growing evidence that CHE can degenerate into OHE quite often and is independently associated with poor prognosis. The West Haven Criteria is the “gold standard” for grading HE form 0–IV grades reflecting increasing severity. Various modalities of testing are available for CHE but is performed in selected centers as it needs special resources and expertise. The treatment of OHE should focus on actively looking for precipitants and triggers, as in majority of cases addressing these alone can reverse OHE. Infections like spontaneous bacterial peritonitis (SBP) and urinary tract infections are the most common precipitating causes for OHE. Lactulose is the best medication to treat the initial episode of OHE with Rifaximin being added for second episode as an add on to Lactulose. Patients with MHE are offered treatment on case-to-case basis if their quality of life is impaired as reflected on psychometric testing. Malnourishment is an unrecognized problem in patients with liver cirrhosis and hence, a formal dietary evaluation and counseling should be done with a goal of optimizing nutritional status. CHE confers poor quality of life and working capabilities along with impaired driving skills. Physicians should counsel patients with MHE about the risks of driving for their own and others safety.

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Authors and Affiliations

  1. Department of Medicine, McGuire VA Medical Center, Richmond, VA, USA

    Jawaid Shaw M.D.

  2. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA

    Jasmohan S. Bajaj M.D., M.S., F.A.C.G., A.G.A.F.

  3. McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA

    Jasmohan S. Bajaj M.D., M.S., F.A.C.G., A.G.A.F.

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  1. Jawaid Shaw M.D.
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Correspondence to Jasmohan S. Bajaj M.D., M.S., F.A.C.G., A.G.A.F. .

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  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin , Milwaukee, Wisconsin, USA

    Kia Saeian

  2. Division of Gastroenterology and Hepatology, Medicine Medical College of Wisconsin , Milwaukee, Wisconsin, USA

    Reza Shaker

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Shaw, J., Bajaj, J.S. (2017). Portosystemic Encephalopathy. In: Saeian, K., Shaker, R. (eds) Liver Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-30103-7_29

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