Specialty Gastroenterology Symptoms Altered level of consciousness , mood changes, personality changes, movement problems [2] Types Acute, recurrent, persistent [3] Causes Liver failure [2] Risk factors Infections , GI bleeding , constipation , electrolyte problems , certain medications [4] Diagnostic method Based on symptoms after ruling out other possible causes [2] [5] Differential diagnosis Wernicke–Korsakoff’s syndrome , delirium tremens , hypoglycemia , subdural hematoma , hyponatremia [1] Treatment Supportive care , treating triggers, lactulose , liver transplant [1] [3] Prognosis Average life expectancy less than a year in those with severe disease [1] Frequency Affects >40% with cirrhosis [6] Hepatic encephalopathy ( HE ) is an altered level of consciousness as a result of liver failure . [2] Its onset may be gradual or sudden. [2] Other symptoms may include movement problems, changes in mood , or changes in personality . [2] In the advanced stages it can result in a coma . [3] Hepatic encephalopathy can occur in those with acute or chronic liver disease. [3] Episodes can be triggered by infections , GI bleeding , constipation , electrolyte problems , or certain medications. [4] The underlying mechanism is believed to involve the buildup of ammonia in the blood, a substance that is normally removed by the liver . [2] The diagnosis is typically based on symptoms after ruling out other potential causes. [2] [5] It may be supported by blood ammonia levels, an electroencephalogram , or a CT scan of the brain. [3] [5] Hepatic encephalopathy is possibly reversible with treatment. [1] This typically involves supportive care and addressing the triggers of the event. [3] Lactulose is frequently used to decrease ammonia levels. [1] Certain antibiotics (such as rifaximin ) and probiotics are other potential options. [1] A liver transplant may improve outcomes in those with severe disease. [1] More than 40% of people with cirrhosis develop hepatic encephalopathy. [6] More than half of those with cirrhosis and significant HE live less than a year. [1] In those who are able to get a liver transplant, the risk of death is less than 30% over the subsequent five years. [1] The condition has been described since at least 1860. [1] Contents 1 Signs and symptoms 2 Causes 3 Pathogenesis 4 Diagnosis 4.1 Investigations 4.2 Classification 4.2.1 West Haven criteria 4.2.2 Types 4.2.3 Minimal HE 5 Treatment 5.1 Diet 5.2 Lactulose/lactitol 5.3 Antibiotics 5.4 L -ornithine and L -aspartate 6 Epidemiology and prognosis 7 History 8 References 9 External links Signs and symptoms [ edit ] The mildest form of hepatic encephalopathy is difficult to detect clinically, but may be demonstrated on neuropsychological testing . ... This is used in the treatment of refractory ascites , bleeding from oesophageal varices and hepatorenal syndrome . [9] [10] TIPS-related encephalopathy occurs in about 30% of cases, with the risk being higher in those with previous episodes of encephalopathy, higher age, female sex, and liver disease due to causes other than alcohol. [8] Pathogenesis [ edit ] Ball and stick model of ammonia; one nitrogen atom with three hydrogen atoms. ... Both the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) [16] and PSE-Syndrom-Test [17] may be used for this purpose. [14] The PSE-Syndrom-Test, developed in Germany and validated in several other European countries, incorporates older assessment tools such as the number connection test. [13] [14] [15] [17] Treatment [ edit ] Those with severe encephalopathy (stages 3 and 4) are at risk of obstructing their airway due to decreased protective reflexes such as the gag reflex . ... PMID 29762873 . ^ a b c Summerskill WH, Davidson EA, Sherlock S, Steiner RE (April 1956). "The neuropsychiatric syndrome associated with hepatic cirrhosis and an extensive portal collateral circulation". ... External links [ edit ] Classification D ICD - 10 : K72 ICD - 9-CM : 572.2 MeSH : D006501 External resources MedlinePlus : 000302 eMedicine : med/3185 article/182208 v t e Diseases of the nervous system , primarily CNS Inflammation Brain Encephalitis Viral encephalitis Herpesviral encephalitis Limbic encephalitis Encephalitis lethargica Cavernous sinus thrombosis Brain abscess Amoebic Brain and spinal cord Encephalomyelitis Acute disseminated Meningitis Meningoencephalitis Brain / encephalopathy Degenerative Extrapyramidal and movement disorders Basal ganglia disease Parkinsonism PD Postencephalitic NMS PKAN Tauopathy PSP Striatonigral degeneration Hemiballismus HD OA Dyskinesia Dystonia Status dystonicus Spasmodic torticollis Meige's Blepharospasm Athetosis Chorea Choreoathetosis Myoclonus Myoclonic epilepsy Akathisia Tremor Essential tremor Intention tremor Restless legs Stiff-person Dementia Tauopathy Alzheimer's Early-onset Primary progressive aphasia Frontotemporal dementia / Frontotemporal lobar degeneration Pick's Dementia with Lewy bodies Posterior cortical atrophy Vascular dementia Mitochondrial disease Leigh syndrome Demyelinating Autoimmune Inflammatory Multiple sclerosis For more detailed coverage, see Template:Demyelinating diseases of CNS Episodic/ paroxysmal Seizures and epilepsy Focal Generalised Status epilepticus For more detailed coverage, see Template:Epilepsy Headache Migraine Cluster Tension For more detailed coverage, see Template:Headache Cerebrovascular TIA Stroke For more detailed coverage, see Template:Cerebrovascular diseases Other Sleep disorders For more detailed coverage, see Template:Sleep CSF Intracranial hypertension Hydrocephalus Normal pressure hydrocephalus Choroid plexus papilloma Idiopathic intracranial hypertension Cerebral edema Intracranial hypotension Other Brain herniation Reye syndrome Hepatic encephalopathy Toxic encephalopathy Hashimoto's encephalopathy Both/either Degenerative SA Friedreich's ataxia Ataxia–telangiectasia MND UMN only: Primary lateral sclerosis Pseudobulbar palsy Hereditary spastic paraplegia LMN only: Distal hereditary motor neuronopathies Spinal muscular atrophies SMA SMAX1 SMAX2 DSMA1 Congenital DSMA Spinal muscular atrophy with lower extremity predominance (SMALED) SMALED1 SMALED2A SMALED2B SMA-PCH SMA-PME Progressive muscular atrophy Progressive bulbar palsy Fazio–Londe Infantile progressive bulbar palsy both: Amyotrophic lateral sclerosis v t e Diseases of the digestive system Upper GI tract Esophagus Esophagitis Candidal Eosinophilic Herpetiform Rupture Boerhaave syndrome Mallory–Weiss syndrome UES Zenker's diverticulum LES Barrett's esophagus Esophageal motility disorder Nutcracker esophagus Achalasia Diffuse esophageal spasm Gastroesophageal reflux disease (GERD) Laryngopharyngeal reflux (LPR) Esophageal stricture Megaesophagus Esophageal intramural pseudodiverticulosis Stomach Gastritis Atrophic Ménétrier's disease Gastroenteritis Peptic (gastric) ulcer Cushing ulcer Dieulafoy's lesion Dyspepsia Pyloric stenosis Achlorhydria Gastroparesis Gastroptosis Portal hypertensive gastropathy Gastric antral vascular ectasia Gastric dumping syndrome Gastric volvulus Buried bumper syndrome Gastrinoma Zollinger–Ellison syndrome Lower GI tract Enteropathy Small intestine ( Duodenum / Jejunum / Ileum ) Enteritis Duodenitis Jejunitis Ileitis Peptic (duodenal) ulcer Curling's ulcer Malabsorption : Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple's Short bowel syndrome Steatorrhea Milroy disease Bile acid malabsorption Large intestine ( Appendix / Colon ) Appendicitis Colitis Pseudomembranous Ulcerative Ischemic Microscopic Collagenous Lymphocytic Functional colonic disease IBS Intestinal pseudoobstruction / Ogilvie syndrome Megacolon / Toxic megacolon Diverticulitis / Diverticulosis / SCAD Large and/or small Enterocolitis Necrotizing Gastroenterocolitis IBD Crohn's disease Vascular : Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction : Ileus Intussusception Volvulus Fecal impaction Constipation Diarrhea Infectious Intestinal adhesions Rectum Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus Anal canal Anal fissure / Anal fistula Anal abscess Hemorrhoid Anal dysplasia Pruritus ani GI bleeding Blood in stool Upper Hematemesis Melena Lower Hematochezia Accessory Liver Hepatitis Viral hepatitis Autoimmune hepatitis Alcoholic hepatitis Cirrhosis PBC Fatty liver NASH Vascular Budd–Chiari syndrome Hepatic veno-occlusive disease Portal hypertension Nutmeg liver Alcoholic liver disease Liver failure Hepatic encephalopathy Acute liver failure Liver abscess Pyogenic Amoebic Hepatorenal syndrome Peliosis hepatis Metabolic disorders Wilson's disease Hemochromatosis Gallbladder Cholecystitis Gallstone / Cholelithiasis Cholesterolosis Adenomyomatosis Postcholecystectomy syndrome Porcelain gallbladder Bile duct / Other biliary tree Cholangitis Primary sclerosing cholangitis Secondary sclerosing cholangitis Ascending Cholestasis / Mirizzi's syndrome Biliary fistula Haemobilia Common bile duct Choledocholithiasis Biliary dyskinesia Sphincter of Oddi dysfunction Pancreatic Pancreatitis Acute Chronic Hereditary Pancreatic abscess Pancreatic pseudocyst Exocrine pancreatic insufficiency Pancreatic fistula Other Hernia Diaphragmatic Congenital Hiatus Inguinal Indirect Direct Umbilical Femoral Obturator Spigelian Lumbar Petit's Grynfeltt-Lesshaft Undefined location Incisional Internal hernia Richter's Peritoneal Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum