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Gastroenterol Rep (Oxf)
2017[May]; 5
(2
): 138-147
PMID28533911
show ga
Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function
occurring in patients with advanced liver diseases. The precise pathophysiology
of HE is still under discussion; the leading hypothesis focus on the role of
neurotoxins, impaired neurotransmission due to metabolic changes in liver
failure, changes in brain energy metabolism, systemic inflammatory response and
alterations of the blood brain barrier. HE produces a wide spectrum of
nonspecific neurological and psychiatric manifestations. Minimal HE is diagnosed
by abnormal psychometric tests. Clinically overt HE includes personality changes,
alterations in consciousness progressive disorientation in time and space,
somnolence, stupor and, finally, coma. Except for clinical studies, no specific
tests are required for diagnosis. HE is classified according to the underlying
disease, the severity of manifestations, its time course and the existence of
precipitating factors. Treatment of overt HE includes supportive therapies,
treatment of precipitating factors, lactulose and/or rifaximin. Routine treatment
for minimal HE is only recommended for selected patients.
free
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