Hepatic encephalopathy

DESCRIPTION: Altered mental and neuromotor functioning associated with acute or chronic liver disease and/or portal systemic shunting of blood. The prominent features are mild to marked forgetfulness, impaired arousability, and a "flapping tremor" (asterixis).

System(s) affected: Gastrointestinal, Nervous

Genetics: Unknown

Incidence/Prevalence in USA:
 

• Occurs in 1/3 cases of cirrhosis
• Occurs in all cases of fulminant hepatic failure
• Present in nearly half of patients who reach the stage of liver disease requiring transplantation

Predominant age: Parallels that of fulminant liver disease with peak in the 40's, and cirrhosis with peak in late 50's. May occur at any age.

Predominant sex: Male = Female (reflecting the underlying liver disease)

CAUSES:
 

• Shunting of intestinal blood through the severely diseased liver without the intervention of viable liver cells. TIPS (transjugular intrahepatic portacaval shunt), a widely used radiologically inserted shunt to lower portal pressure, produces liver encephalopathy.
• Shunting of such blood through collateral circulation or surgically constructed portacaval shunts
• Most common in long standing cirrhosis of the liver with spontaneous shunting of intestinal blood through collaterals.
• Failure of liver to detoxify agents noxious to CNS, eg, ammonia, mercaptans, fatty acids
• Increased aromatic and reduced branched chain amino acids in blood
• Precipitation of acute event, search for:
  • New overt or occult infection including spontaneous peritonitis
  • Potassium, magnesium or other electrolyte depletion
  • Use of opiate, sedative, tranquilizer, drugs
  • Gastrointestinal bleeding

SYNONYMS:
 

• Hepatic coma
• Liver coma

ICD-9-CM: 572.2 Hepatic encephalopathy

REFERENCES:
 

• Cordoba J, Blei AT. Treatment of hepatic encephalopathy. Am J Gastroenter 1997;92:1429-1439
• Haussinger D. Pathogenesis and treatment of chronic hepatic encephalopathy. Digestion 1998;59(Suppl2):25-27

Web References:
 

• NLM (National Library of Medicine)
   Website  

Date last updated: 9/12/01