HEPATIC ENCEPHALOPATHY

Chronic liver disease may cause broad spectrum of systemic manifestations that may influence the clinical course. Hepatic encephalopathy (HE) incorporates a spectrum of neuropsychiatric abnormalities seen in patients with liver dysfunction without brain disease. The exact patophysiological mechanisms are still not completely defined. Hepatic encephalopathy is predominantly seen in patients with chronic liver disease and portal hypertension with shunting of blood, bypassing the liver. The onset is often insidious characterized by subtle and sometimes intermittent memory changes, changes of one’s personality, concentration and reaction time. Manifestations of hepatic encephalopathy are nonspecific, and it is important to exclude alternative diagnosis before starting the therapy. The treatment of hepatic encephalopathy in patients with acute and chronic liver failure is quite distinct. Beside clinically manifested hepatic encephalopathy, there is also a subclinical stage defined as subtle or subclinical neuropsychological deficit present in patients with liver disease which cannot be detected by routine clinical examination.