The Washington Manual of Medical Therapeutics helps you diagnose and treat hundreds of medical conditions. Consult clinical recommendations from a resource that has been trusted on the wards for 50+ years. Explore these free sample topics:
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- Hepatic encephalopathy is the syndrome of disordered consciousness and altered neuromuscular activity that is seen in patients with acute or chronic hepatocellular failure or portosystemic shunting.
- Hepatic encephalopathy is classified according to the underlying disease into the following:
- Type A: Resulting from acute liver failure
- Type B: Resulting from portosystemic bypass or shunting
- Type C: Resulting from cirrhosis.1
- The grades of hepatic encephalopathy are dynamic and can rapidly change.
- Grade I: Sleep reversal pattern, mild confusion, irritability, tremor, asterixis
- Grade II: Lethargy, disorientation, inappropriate behavior, asterixis
- Grade III: Somnolence, severe confusion, aggressive behavior, asterixis
- Grade IV: Coma
- Precipitating factors include medication noncompliance to lactulose, azotemia, FHF, opioids or sedative-hypnotic medications, acute GI bleeding, hypokalemia and alkalosis (diuretics and diarrhea), constipation, infection, high-protein diet, progressive hepatocellular dysfunction, and portosystemic shunts (surgical or TIPS).