Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver disease and hepatic insufficiency. It can cause personality changes, intellectual impairment, reduced consciousness, and altered neuromuscular activity. It is classified into different types depending on the underlying liver disease. Serum ammonia levels are raised in 90% of cases. Treatment focuses on reducing ammonia production and absorption in the gut, typically using non-absorbable disaccharides like lactulose or antibiotics like rifaximin. Rifaximin has been shown to be more effective than lactulose at reducing recurrence of hepatic encephalopathy episodes.