Guide
Hepatic encephalopathy (HE) is a very common, life-threatening complication of cirrhosis. Depending on the underlying liver disease, HE can be classified as type A (due to acute liver disease), type B (due to portosystemic shunt without any liver disease), and type C (due to cirrhosis). This article mainly reviews C-type HE.
Methods for diagnosing HE
For the classification of HE, the most commonly used at home and abroad is the West Haven grading standard, which divides HE into grades 0-4. Among them, grade 0 may represent mild hepatic encephalopathy (MHE), and grade 2-4 HE is overt hepatic encephalopathy (OHE). The diagnostic algorithms for MHE and OHE are shown in the figure below.
Figure 1 Diagnostic algorithm for MHE
PHES，肝性脑病心理测量评分；CFF，临界闪烁频率试验；ICT，抑制控制试验；EEG，脑电图
Figure 2 Diagnostic algorithm for OHE
Treatment of HE
The management of HE is based on the following principles: (1) exclusion of other HE-like conditions; (2) assess the severity of HE to manage patients with altered consciousness in the ICU; (3) identification and treatment of precipitating factors; (4) empiric ammonia-lowering therapy; (5) Prevention of HE recurrence. Figure 3 summarizes the treatment algorithm for HE.
Fig.3 Treatment algorithm for HE
TIPS, Transjugular Intrahepatic Portosome Shunt, PPI, Proton Pump Inhibitor, LOLA, Ornidine Aspartate, BCAAs, BCAAs
参考文献：Rudler M, Weiss N, Bouzbib C, et al. Diagnosis and Management of Hepatic Encephalopathy[J]. Clin Liver Dis. 2021 May; 25(2):393-417. doi: 10.1016/j.cld.2021.01.008.
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