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Introduction Hepatic encephalopathy (HE) is a very common and life-threatening complication of liver cirrhosis
.
According to the underlying liver disease, HE can be divided into type A (caused by acute liver disease), type B (caused by portosystemic shunt without any liver disease), and type C (caused by cirrhosis)
.
This article mainly reviews the type C HE
.
The diagnosis method of HE For the classification of HE, the West Haven classification standard is the most commonly used at home and abroad, and HE is divided into grades 0-4
.
Among them, grade 0 represents possible mild hepatic encephalopathy (MHE), and grades 2-4 represent overt hepatic encephalopathy (OHE)
.
The diagnostic algorithms for MHE and OHE are shown in the figure below
.
Fig.
1 Diagnostic algorithm of MHEPHES, psychometric score for hepatic encephalopathy; CFF, critical flicker frequency test; ICT, inhibitory control test; EEG, electroencephalogram Principles: ① Exclude other similar conditions of HE; ② Assess the severity of HE to manage patients with altered consciousness in the ICU; ③ Identify and treat precipitating factors; ④ Empirical ammonia-lowering therapy; ⑤ Prevent HE recurrence
.
Figure 3 summarizes the treatment algorithm for HE
.
Figure 3 Treatment algorithm for HE TIPS, Transjugular Intrahepatic Portosystemic Shunt; PPI, Proton Pump Inhibitor; LOLA, Ornithine Aspartate; BCAA, Branched Chain Amino Acids 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.
.
According to the underlying liver disease, HE can be divided into type A (caused by acute liver disease), type B (caused by portosystemic shunt without any liver disease), and type C (caused by cirrhosis)
.
This article mainly reviews the type C HE
.
The diagnosis method of HE For the classification of HE, the West Haven classification standard is the most commonly used at home and abroad, and HE is divided into grades 0-4
.
Among them, grade 0 represents possible mild hepatic encephalopathy (MHE), and grades 2-4 represent overt hepatic encephalopathy (OHE)
.
The diagnostic algorithms for MHE and OHE are shown in the figure below
.
Fig.
1 Diagnostic algorithm of MHEPHES, psychometric score for hepatic encephalopathy; CFF, critical flicker frequency test; ICT, inhibitory control test; EEG, electroencephalogram Principles: ① Exclude other similar conditions of HE; ② Assess the severity of HE to manage patients with altered consciousness in the ICU; ③ Identify and treat precipitating factors; ④ Empirical ammonia-lowering therapy; ⑤ Prevent HE recurrence
.
Figure 3 summarizes the treatment algorithm for HE
.
Figure 3 Treatment algorithm for HE TIPS, Transjugular Intrahepatic Portosystemic Shunt; PPI, Proton Pump Inhibitor; LOLA, Ornithine Aspartate; BCAA, Branched Chain Amino Acids 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.
