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transjugular intrahepatic portosystemic shunt

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3.3.6 - Encephalopathy
from Section 3.3 - Acute Liver Failure
- By Michael Spiro, Jeremy Fabes
Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
Book:

Intensive Care Medicine

Published online:

27 July 2023

Print publication:

01 December 2021, pp 174-176
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Summary

Key Learning Points
1. Encephalopathy describes potentially reversible neuropsychiatric abnormalities that are common in those with liver failure.
2. A wide range of motor and cognitive defects are described in hepatic encephalopathy, with clinical grading by the West Haven classification.
3. Investigations are useful to determine the aetiology of encephalopathy and to exclude differentials.
4. Whilst there is a clear role for ammonia in the pathogenesis, raised ammonia levels are not necessary or sufficient for a diagnosis of hepatic encephalopathy.
5. Management is aimed at correcting the underlying precipitant, lowering systemic ammonia absorption, and managing symptoms and complications.