Hepatic Encephalopathy: Diagnosis and Current Therapies

Hepatic encephalopathy (HE) is a neuropsychological, and a serious neurotoxic disease. HE varies in clinical presentation, in pathogenesis and treatment. HE is caused by the accumulation in the bloodstream of toxic substances that are normally removed by the liver.Clinical manifestations of HE include a wide spectrum of neuropsychiatric and neurological symptoms, disorientation and poor coordination. Acute HE is associated with severe liver failure in patients with fulminant hepatic failure. In chronic HE have neuropsychiatric syndrome characterized with depression of the central nervous system, with varying degrees of severity. HE is traditionally graded into four clinical stages. The synergistic effects of excess ammonia and inflammation cause astrocyte swelling and cerebral edema. Diagnosis of HE include neuropsychometric tests, brain imaging and clinical scales, the West Haven Criteria. Treatment is based on reducing the production and absorption of ammonia, with anti-microbial agent as rifaximin, and lactulose with probiotics added.