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  • Guang Chen

Hepatic encephalopathy (HE)

Hepatic encephalopathy (HE) is a condition characterized by brain dysfunction resulting from acute and/or chronic liver dysfunction. The term “hepatic” refers to the liver, while “encephalopathy” indicates brain-related issues.


  1. Symptoms of Hepatic Encephalopathy:

  • HE can manifest in various ways. There may be no symptoms in early and mild disease.

  • Mood and personality: Changes in behavior and impulse control.

  • Memory and concentration: Altered thinking and confusion.

  • Consciousness and sleep patterns: Disorientation and erratic sleep.

  • Motor functions and coordination: Abnormal movements.

  • Autonomy: Ability to care for oneself.

  • Symptoms may vary in severity and can occur suddenly or gradually.

  1. Causes:

  • HE is thought to arise from chemicals that pass into the brain. These chemicals are usually filtered by the liver.

  1. Grading System:

  • The West Haven Criteria grades HE symptoms on a scale of 0 to 4:

  • Minimal Hepatic Encephalopathy (MHE) (Stages 0-1): Subtle changes in memory, concentration, and reaction time.

  • Overt Hepatic Encephalopathy (Stages 2-4): More noticeable symptoms, including confusion and altered consciousness.

  1. Complications and Risk:

  • If left untreated, HE can lead to serious complications.

  • The severity of HE may also reflect the severity of liver disease.

  1. Prevention and Management (not limited to the following):

  • Avoid/minimize/treat other liver risk factors: Alcohol, viral hepatitis, metabolic liver disease, etc.

  • Avoid certain medications: eg Benzodiazepines and barbiturates.

  • Vaccination against viral hepatitis

  • Exercise and maintain a healthy weight

  • Diet

  • Medication

  • Liver transplantation: may be considered for severe cases.

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