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3.3.6 - Encephalopathy

from Section 3.3 - Acute Liver Failure

Published online by Cambridge University Press:  27 July 2023

By
Michael Spiro  and
Jeremy Fabes
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Encephalopathy describes potentially reversible neuropsychiatric abnormalities that are common in those with liver failure.

  2. 2. A wide range of motor and cognitive defects are described in hepatic encephalopathy, with clinical grading by the West Haven classification.

  3. 3. Investigations are useful to determine the aetiology of encephalopathy and to exclude differentials.

  4. 4. Whilst there is a clear role for ammonia in the pathogenesis, raised ammonia levels are not necessary or sufficient for a diagnosis of hepatic encephalopathy.

  5. 5. Management is aimed at correcting the underlying precipitant, lowering systemic ammonia absorption, and managing symptoms and complications.

Keywords

hepatic encephalopathyammoniatransjugular intrahepatic portosystemic shuntTIPSS
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 174 - 176
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Felipo, V. Hepatic encephalopathy: effects of liver failure on brain function. Nat Rev Neurosci 2013;14:851–8.CrossRefGoogle ScholarPubMed
Suraweera, D, Sundaram, V, Saab, S. Evaluation and management of hepatic encephalopathy: current status and future directions. Gut Liver 2016;10:509–19.Google ScholarPubMed
Wijdicks, E. Hepatic encephalopathy. N Engl J Med 2016;375:1660–70.CrossRefGoogle ScholarPubMed

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