Hepatic Encephalopathy
Reversible neuropsychiatric syndrome resulting from liver dysfunction and portosystemic shunting, allowing gut derived neurotoxins, principally ammonia, to bypass hepatic clearance and reach the brain, causing astrocyte swelling and altered neurotransmission.
Occurs in acute liver failure and, more commonly in everyday practice, as a complication of decompensated cirrhosis.
Classified by the West Haven criteria: Grade I (subtle changes, mild confusion, altered sleep pattern, shortened attention span), Grade II (lethargy, disorientation, personality change, asterixis present), Grade III (marked confusion, somnolence but rousable, gross disorientation), and Grade IV (coma, unresponsive to stimuli).
