Hepatic encephalopathy is a brain disorder caused by liver dysfunction. There are three types: type A from acute liver failure, type B from portosystemic shunting without liver damage, and type C from chronic liver disease. Symptoms range from insomnia to coma and are graded on a scale of 0 to 4 based on consciousness, intellectual function, and neurological signs. Treatment includes lactulose to reduce ammonia absorption, antibiotics like neomycin, and liver transplantation for severe cases.

3. Hepatic encephalopathy is a type of brain
disorder that occurs as a result of liver
dysfunction.

4.  Type A: Associated with acute liver failure.
 Type B: Occurs when there is no primary liver damage
and encephalopathy occurs due to portosystemic shunting
of blood.
 Type C: Associated with chronic liver disease such as
cirrhosis and portal hypertension. The encephalopathy can
either be episodic (acute) or persistent (chronic).

5.  Chronic hepatitis
 Cirrhosis
 Acute viral hepatitis

6. Grade Level of consciousness Intellectual function Neurologic function
0 Insomnia, sleep disturbance Change in computation skills Impaired handwriting
1 Lack of awareness, personality
change
Short attention span, mild
confusion, depression
Incoordination , asterixis
2 Lathergy, drowsiness,
inappropriate behaviour
Disoriented Astrexis, abnormal reflexes
3 Asleep, rousable Loss of meaningful
conversation, marked confusion,
incomprehensible speech
Asterixis, abnormal reflexes
4 Not rousable Absent Decerebrate

8.  Health history
 Physical examination
 Blood test
 CSF analysis
 CT/MRI of brain
 Electroencephalogram
 Hepatic function

9.  Lactulose -Patients should take sufficient lactulose as to have
2-4 loose stool per day.
 Oral magnesium sulphate or enemas are given after
haemorrhage to clean out the intestine.
 Antibiotic:
- Neomycin; Initial dose is 250 mg orally 2-4 times a
day. Neomycin is usually reserved as a second line
treatment after initiation of treatment with lactulose.
- Rifaximin; dose of 400 mg taken orally 3 times a day
was effective as lactulose.
 Hydroxyzine 25mg at bed time to improve quality of sleep.

10. Additional management:
 Regular assessment of neurological function
 Record fluid input and output
 Vital monitoring daily 4hourly
 Serum ammonia level monitored daily.
 GI suction to reduce absorption of ammonia.

11.  Liver transplantation surgery is indicated for chronic
or refractory hepatic encephalopathy.

12. 1.Ineffective breathing pattern related to hypoxia as
evidenced by lower respiratory rate.
2.Deficient fluid volume related to bleeding, decreased
intake as evidenced by physical examination.
4.Imbalanced nutrition: less than body requirement
related to diet restriction as evidenced by fatigue.

13. 5.Deficient knowledge related to disease process, it
control as evidenced by frequent questioning by the
patient and family members.
6.Ineffective individual coping related to stress imposed
by chronic illness
3.Risk for infection related to immune compromise
secondary to chronic illness.