Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver failure that results in a reversible decrease in brain function. It is most common in patients with cirrhosis. Symptoms include disturbances in consciousness, personality changes, neurological signs like tremors, and confusion. It is caused by factors that increase the level of toxins in the blood that are normally processed by the liver, such as infections, bleeding, or kidney failure. Diagnosis is clinical but may include blood tests showing elevated ammonia levels or EEG changes. Treatment focuses on removing the precipitating cause and aiding liver function.

1. DR. Prof. Balvir Singh
(MBBS. M.D. Medicine ,MNAMS,FICP,FIACM)

2. Hepatic encephalopathy
Hepatic encephalopathy is a neuropsychiatric
syndrome caused by hepatic insufficiency
It represents a reversible decrease in neurologic
function, based upon the disorder of metabolism
which are caused by severe decompensated liver
disease
“Portal-systemic encephalopathy” - patients with
portal hypertension abnormal shunting of blood
It occurs most often in patients with cirrhosis but
also occur in acute hepatic failure.

3. Causes:
 Chronic parenchymal liver disease:
 Chronic hepatitis:
 Cirrhosis.
 Fulminating hepatic failure:
 Acute viral hepatitis
 Drugs
 Toxins e.g. Wilson’s Disease, CCL4,
Surgical Portal-systemic anastomoses, portacaval shunts, or Transjugular intrahepatic
portal-systemic shunting [TIPS]).

4. Factors precipitating hepatic encephalopathy:



Metabolic stress
 Infection
 Electrolyte imbalance, especially hypokalemia;
 Dehydration , Renal failure
 Diuretic drugs,
Disorders that increase gut protein
 GI bleeding
 High-protein diet
Nonspecific cerebral depressants
 alcohol, sedatives, analgesics

5. PATHOPHYSIOLOGY

13. Clinical Features of hepatic
encephalopathy:
A Disturbance in consciousness
 Disturbances in sleep rhythm.
 Impaired memory/ apraxia
 Mental confusion.
 Apathy.
 Drowsiness / Somnolence
 Coma.

14. B. Changes Personality
 Childish behavior.
 May be aggressive out burst.
 Euphoric.
 Foetor hepaticus – Foul–smelling
breath associated with liver disease
due to mercaptans

15. C Neurological signs:
 Flapping tremor / Asterixis (in pre
coma).
 Exaggerated tendon reflex.
 Extensor plantar reflex.

16. Clinical stages of Hepatic Encephalopathy

17. Investigations
Diagnosis is usually made clinically
 No Pathognomonic liver function
abnormality
 Elevation of blood ammonia
 Hypokalaemia
 EEG (Electroencephalogram)
 CSF & CT Scan – Normal
 Other Routine Investigations TC, DC, ESR, Hb, Na, k, Urea, Creatinine,
Prothrombin time

18. Differential Diagnosis
 Subdural Haematoma
 Drug or Alcohol intoxication
 Wernicke’s encephalopathy
 Hypoglycaemia