Alerts and Notices
SynopsisHepatic encephalopathy (HE) is characterized by hepatic dysfunction and a multitude of potentially reversible neuropsychiatric changes, including impaired neuromuscular function and cognitive defects. HE is frequently associated with worsening acute liver failure, advanced cirrhosis, and TIPS (transjugular intrahepatic portal-systemic shunts). Patients typically have stigmata of underlying chronic liver disease, including jaundice, ascites, spider telangiectasias, and muscle wasting.
Overt HE is defined by inattention, personality change, prolonged reaction time, impaired working memory, asterixis, myoclonus, and, if severe, possible progression to coma. Patients can appear parkinsonian with rigidity, bradykinesia, shuffling gait, and tremor. Alternatively, minimal HE may be present in up to 80% of cirrhotic patients and is characterized by subtle cognitive changes. The spectrum of changes is frequently graded according to the West Haven criteria:
- Grade 1 includes mild decreased attention span, hypersomnia, a slowness of thinking, mood changes, and slight confusion;
- Grade 2 includes lethargy, disorientation (especially to time), dysarthria, asterixis, and personality changes;
- Grade 3 includes disorientation to time and place, somnolence, disordered speech, memory impairment, and marked confusion;
- Grade 4 progresses to coma.
K72.91 – Hepatic failure, unspecified with coma
13920009 – Hepatic Encephalopathy
Differential Diagnosis & PitfallsDifferential includes any cause of confusion, including:
- Drugs / toxins (eg, opioids, antipsychotics, drugs of abuse, poisons)
- Endocrine pathology (ie, thyroid, pituitary, parathyroid changes)
- Hyperglycemia or hypoglycemia
- Renal failure
- Liver failure
- Hematologic disease (ie, anemia, thrombocytosis, polycythemia)
- Hypercarbia, hypoxemia from pulmonary disease
- Subdural hematoma
- Central nervous system (CNS) infection
- Psychiatric disorder
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.