Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ DEFINITION ++ Hepatic encephalopathy (HE) defines a spectrum of neurologic and neuropsychiatric irregularities that develop in a patient with liver disease, after other causes are ruled out. It can range from minimal hepatic encephalopathy (MHE) and covert hepatic encephalopathy (CHE) to overt hepatic encephalopathy (OHE) with significant symptoms and impairment (Fig. 14-1). It was described by Hippocrates (460–371 BC) when he stated that the “yellow bile causes the patient to thrash around.” Although it is considered a completely reversible syndrome, some research establishes an accumulative effect in cognition deficits of affected patients over time. ++ FIGURE 14-1 Progression of HE. Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ CLASSIFICATION ++ Based on the underlying cause, HE can be classified as type A, HE associated with acute liver failure; type B. HE with a portosystemic bypass and no intrinsic liver disease; and type C, HE associated with cirrhosis or portal hypertension (Table 14-1). The most commonly used classification system is the West Haven Criteria (WHC) classification, which is based on clinical findings (Table 14-2). MHE is described as subtle neuropsychological alterations only identifiable by psychometric tests and with no clinical manifestations. MHE occurs before WHC grade 1. HE can be also classified as episodic, recurrent, or persistent based on its time course (Fig. 14-2). According to the identification of triggers, HE can be spontaneous or precipitated. In type C HE, almost all the time a trigger can be identified (Table 14-3). In summary, if we combine all classifications, we will have a complete picture of the HE in any particular patient (Table 14-4). ++ FIGURE 14-2 HE time course classification. Graphic Jump LocationView Full Size||Download Slide (.ppt) ++Table Graphic Jump LocationTABLE 14-1HE Classified by Underlying CauseView Table||Download (.pdf) TABLE 14-1 HE Classified by Underlying Cause Type Description A HE associated with acute overt liver failure B HE with portosystemic bypass and no intrinsic liver disease C HE associated with cirrhosis and portal hypertension ++Table Graphic Jump LocationTABLE 14-2West Haven Criteria for Hepatic EncephalopathyView Table||Download (.pdf) TABLE 14-2 West Haven Criteria for Hepatic Encephalopathy Grade Description 1 Trivial lack of awareness Euphoria or anxiety Shortened attention span Impaired performance of addition Covert HE 2 Lethargy or apathy Minimal disorientation for time of place Subtle personality change Impaired performance of subtraction Asterixis 3 Somnolence to semi-stupor, but responsive to verbal stimulus Confusion Gross disorientation Overt HE 4 Coma, unresponsive to stimuli ++Table Graphic Jump LocationTABLE 14-3Triggers of HEView Table||Download (.pdf) TABLE 14-3 Triggers of HE Infections Electrolyte imbalance Gastrointestinal hemorrhage Poor lactulose compliance Constipation Post-TIPS procedure Dietary protein overload Bowel obstruction or ileus Dehydration Uremia Drugs Hepatocellular carcinoma TIPS, Transjugular intrahepatic portosystemic shunt.... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.