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Hepatic Encephalopathy

Walter M. Kim, MD, PhD Reviewed 06/2020
 


BASICS

DESCRIPTION

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

  • The prominent features are confusion, i...

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

  • Assessment of asterixis and using the trail-making test (ask patient to connect-the-dots according to number...

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 Diseases and the European ...

ADDITIONAL READING

  • Konerup LS, Gluud LL, Vilstrup H, et al. Update on the therapeutic management of hepatic encephalopathy. Curr Gastroenterol Rep.  2018;20(5):21.

  • McGee RG, Bakens A, Wiley K, et ...

CODES

ICD10

  • K72.90 Hepatic failure, unspecified without coma

  • K72.91 Hepatic failure, unspecified with coma

ICD9

572.2 Hepatic encephalopathy 

SNOMED

  • 13920009 Hepatic encephalopathy (disorder)

  • 72836002 Hepati...

CLINICAL PEARLS

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

  • Lactulose is a cornerstone of therapy for HE.

  • Asterixis (“liv...

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