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Hepatic Encephalopathy

Walter M. Kim, MD, PhD and Jyoti Ramakrishna, MD, MPH Reviewed 06/2019
 


BASICS

DESCRIPTION

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

  • The prominent features are confusion,...

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: GI bleeding, infection, electrolyte imbalance.

  • Eliminate offending medications.

  • Grade I or higher: Ensure adequate fluid and caloric ≥1...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Activity as tolerated once resolved 

Patient Monitoring

  • Trail-making test (a pencil/paper connect-the-dots according to numbers) and assessment of asterixis help to...

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

  • McGee RG, Bakens A, Wiley K, et al. Probiotics for patients with hepatic encephalopathy. Cochrane Database Syst Rev.  2011;(11):CD008716. [View Abstract on OvidMedline]

  • Sturgeon...

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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