Clinical overview
Hepatic encephalopathy is a complex neuropsychiatric syndrome, the symptoms of which include:
Stage 1 (Minimal HE)
- Confusion or amnesia
- Euphoria or depression
- Lack of attention or inability to perform mental tasks
- Irritability
- Altered circadian rhythms, sleep/wake cycle
- Slight tremors, lack of coordination
- Asterixis
- Somnolence, lethargy
- Great difficulty to perform mental tasks
- Abnormal reflexes
- Personality changes
- Intermittent disorientation
- Somnolence
- Inability to perform mental tasks
- Important disorientation
- Marked confusion
- Amnesia
- Incomprehensible speech
- Abnormal reflexes
- Coma
- Presence of Babinski signs
- Cerebral herniation
Causes
HE occurs in patients with a damaged or dysfunctional liver, or who have experienced liver failure.
Acute (generally within days)- Intoxication (hepatotoxin, acetaminophen)
- Viral hepatitis
- ornithine transcarbamylase deficiency
- cirrhosis
- portal hypertension
References
- Parsons-Smith, B.S., Summerskill, W.H.J., Dawson, A.M., and Sherlock, S. (1957). The electroencephalographin liver disease. Lancet. 2:867-871.
- Conn, H., and Lieberthal, M.M. (1979). The Hepatic Coma Syndromes and Lactulose, Lippincott Williams &Wilkins, Baltimore.
Ammonia