Intensive care medicine

Engineering

Transjugular intrahepatic portosystemic shunt

Biology

Liver disease

Cirrhosis

Current (fluid)

Portal hypertension

Physics

Complication

Encephalopathy

Rifaximin

Hepatic encephalopathy

Optics

Lactulose

Antibiotics

Liver failure

Microbiology

Internal medicine

Delirium

Medicine

Coma (optics)

Gastroenterology

Pathogenesis

Portosystemic shunt

Electrical engineering

Hepatic Medicine Evidence and Research

Abstract: Hepatic encephalopathy (HE) is a common complication of liver dysfunction, including acute liver failure and liver cirrhosis. HE presents as a spectrum of neuropsychiatric symptoms ranging from subtle fluctuating cognitive impairment to coma. It is a significant contributor of morbidity in patients with liver disease. HE is observed in acute liver failure, liver bypass procedures, for example, shunt surgery and transjugular intrahepatic portosystemic shunt, and cirrhosis. These are classified as Type A, B and C HE, respectively. HE can also be classified according to whether its presence is overt or covert. The pathogenesis is linked with ammonia and glutamine production, and treatment is based on mechanisms to reduce the formation and/or removal of these compounds. There is no specific diagnostic test for HE, and diagnosis is based on clinical suspicion, excluding other causes and use of clinical tests that may support its diagnosis. Many tests are used in trials and experimentally, but have not yet gained universal acceptance. This review focuses on the definitions, pathogenesis and treatment of HE. Consideration will be given to existing treatment, including avoidance of precipitating factors and novel therapies such as prebiotics, probiotics, antibiotics, laxatives, branched-chain amino acids, shunt embolization and the importance of considering liver transplant in appropriate cases. Keywords: hepatic encephalopathy, pathogenesis, treatment, lactulose, rifaximin, probiotics, covert hepatic encephalopathy

Hepatic encephalopathy: current challenges and future prospects