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Hepatic Encephalopathy

Walter M. Kim, PhD, MD and Kevin Hoang, MD Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Reversible altered mental and neuromotor functioning in association with acute or chronic liver disease and/or portosystemic shunting

  • Wide spectrum of neurological/psychiatric abnorma...

DIAGNOSIS

HISTORY

  • Preexisting liver disease

  • Confusion; altered mental status

  • Impaired arousability

  • Constipation

PHYSICAL EXAM

  • Age 10 to 60 years

    • Five grades of confusion and degree of obtundation (West Haven...

TREATMENT

GENERAL MEASURES

  • Identify and treat precipitating causes: electrolyte imbalance, GI bleeding, infection

  • Avoid sedatives, benzodiazepines, opiates, diphenoxylate, and atropine.

  • Grade I or highe...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Activity as tolerated once resolved 

Patient Monitoring

  • Asterixis and using the trail-making test (ask patient to connect-the-dots according to numbers) helps monit...

REFERENCES

1
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...

ADDITIONAL READING

  • Acharya C, Bajaj JS. Current Management of Hepatic Encephalopathy. Am J Gastroenterol. 2018 Nov; 113 (11):1600-1612.

  • Konerup LS, Gluud LL, V...

SEE ALSO

Algorithm: Delirium 

CODES

ICD10

  • K72.91 Hepatic failure, unspecified with coma

  • K72.11 Chronic hepatic failure with coma

  • K70.40 Alcoholic hepatic failure without coma

  • K72.90 Hepatic failure, unspecified without coma

  • K72.9 Hepat...

CLINICAL PEARLS

  • HE includes a spectrum of neuropsychiatric findings that occur in patients with significant alterations in hepatic function.

  • Lactulose helps reduce serum ammonia levels and is a corners...

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