Hepatology

1. Hepatic encephalopathy
Dr. Sunil Thomas George

2. Introduction
 Hepatic encephalopathy describes a spectrum of potentially reversible neuropsychiatric
abnormalities seen in patients with liver dysfunction and/or portosystemic shunting
 The International Society for Hepatic Encephalopathy and Nitrogen Metabolism consensus
defines the onset of disorientation or asterixis as the onset of overt hepatic encephalopathy

3. CATEGORIZATION AND GRADING
 Hepatic encephalopathy is categorized based on four factors:
1. Underlying disease
2. Severity of manifestations
3. Time course
4. Precipitating factors
Based on West haven’s Criteria

4. Clinical features

5. Lab abnormality
 Elevated arterial and venous ammonia concentrations
 Other potential markers - serum levels of 3-nitrotyrosine may be elevated in patients with
minimal hepatic encephalopathy.

6. Evaluation of
precipitating causes

7. Management
 Acute therapy - The initial management of acute hepatic encephalopathy in patients with chronic
liver disease involves two steps:
●Identification and correction of precipitating causes
●Measures to lower the blood ammonia concentration – Lactulose, gut sterilization

8.  Chronic therapy – with lactulose or lacitol aiming at 2 -3 soft stools per day
 Nutritional therapy - In a trial that compared a daily diet of 30 to 35 kcal/kg and 1.0 to 1.5 g
vegetable protein/kg with no dietary intervention in 120 cirrhotic patients with MHE, the rate of
reversal of MHE was greater in those receiving nutritional therapy

9. Thank you