Introduction
Hepatic encephalopathy (HE ) is a very common, life-threatening complication of cirrhosis. According to the underlying liver disease, HE can be divided into type A (caused by acute liver disease), type B (caused by portosystemic shunt without any liver disease), and type C (caused by cirrhosis). This article mainly reviews the type C HE.
Diagnosis of HE
Grading of HE , the most commonly used at home and abroad is the West Haven grading standard, which divides HE into grades 0-4. Among them, grade 0 represents possible mild hepatic encephalopathy (MHE), and grades 2-4 represent overt hepatic encephalopathy (OHE). The diagnostic algorithms for MHE and OHE are shown in the figure below.
Figure 1 Diagnostic algorithm of MHE p>
PHES, hepatic encephalopathy psychometric score; CFF, critical flicker frequency test; ICT, inhibitory control test; EEG, electroencephalogram
Figure 2 OHE diagnosis algorithm
< Treatment of HE
The management of HE is based on the following principles: ① exclusion of other conditions similar to HE; ② assessment of the severity of HE, Management of patients with altered consciousness in the ICU; ③ identification and treatment of precipitating factors; ④ empirical ammonia-lowering therapy; ⑤ prevention of HE recurrence. Figure 3 summarizes the treatment algorithm for HE.
References: Rudler M, Weiss N, Bouzbib Hepat Diasis C, et al. Encephalopathy[J]. Clin Liver Dis. 2021 May;25(2):393-417. doi: 10.1016/j.cld.2021.01.008.