Hepatic Encephalopathy : (portal systemic encephalopathy) Explained

Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver disease.
It most often results from high gut protein or acute metabolic stress (eg, GI bleeding, infection, electrolyte abnormality) in a patient with portal-systemic shunting
As it progresses, confusion is followed by coma.
Confusion needs to be differentiated from delirium tremens and Wernicke’s encephalopathy, and coma from subdural haematoma, which can occur in alcoholics after a fall
Features include changes of intellect ,personality, emotions and consciousness, with or without neurological signs
Two broad categories of hepatic encephalopathy are
covert (CHE) and
overt (OHE) hepatic encephalopathy
CHE is particularly associated with poor outcomes
Hepatic encephalopathy is also classified into three types based on the disease state of the liver, as follows:
Type A: Hepatic encephalopathy associated with acute liver failure
Type B: Hepatic encephalopathy associated with portosystemic bypass with no intrinsic hepatocellular disease
Type C: Hepatic encephalopathy associated with cirrhosis and portal hypertension or portosystemic shunts.
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