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Medical Student
Universidad Iberoamericana
Introduction & Pathophysiology
Hepatic encephalopathy (HE), also known as portosystemic encephalopathy, is a potentially deadly complication of chronic liver failure. HE is commonly caused by liver failure due to cirrhosis, but there are non-cirrhotic causes as well. Cirrhosis is commonly caused by alcohol abuse and hepatitis B & C, each of which contribute to chronic liver scarring.[1] Symptoms are similar regardless of the underlying etiology. The basis of hepatic encephalopathy is ammonia accumulation in the brain, which produces drastic motor and cognitive impairment.[3] HE results in a constellation of neurological problems that includes chronic fatigue, difficulty thinking, forgetfulness, asterixis, poor judgment, excessive confusion, disorientation, personality changes, and hyperactive deep tendon reflexes.[2] Patients with HE may also demonstrate stigmata of chronic liver disease: jaundice, ascites, peripheral edema, telangiectasias, caput medusae, and palmar erythema. In general, physicians use scoring systems, such as the West Haven Criteria, when diagnosing HE because of the variety of symptoms HE can cause in any individual patient. The criteria depend on the severity of the patients’ clinical symptoms, whether they are cognitive, motor, or both (see summary in table 1). [2,4]
