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__NOTOC__
__NOTOC__
{{Hepatic encephalopathy}}
{{Hepatic encephalopathy}}
{{CMG}}
{{CMG}} ; {{AE}}{{MMJ}}
 
==Overview==
Hepatic [[encephalopathy]] may be classified based on underlying liver disease into three types type A (acute), Type B (bypass) and type C ([[cirrhosis]]). The evaluation of severity of persistent hepatic [[encephalopathy]] is based on the West Haven Criteria. It includes [[mental status]],  level of impairment of autonomy, changes in [[consciousness]], intellectual function, behavior, and the dependence on therapeutic factors into grading.


==Classification==
==Classification==
In the World Congress of [[Gastroenterology]] 1998 in Vienna, a proposed classification of hepatic encephalopathy was presented to standardize the subclasses. According to this classification, hepatic encephalopathy is subdivided in type A, B and C.<ref name=Ferenci>{{cite journal |author=Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei A |title=Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998 |journal=Hepatology |volume=35 |issue=3 |pages=716-21 |year=2002 |pmid=11870389}}</ref>
* Type A (Acute) describes hepatic encephalopathy associated with acute liver failure;
* Type B ([[Bypass (surgical)|Bypass]]) is caused by portal-systemic shunting without associated intrinsic liver disease;
* Type C (Cirrhosis) occurs in patients with [[cirrhosis]].


In addition, the duration and characteristics of hepatic encephalopathy were classified into ''episodic'', ''persistent'' and ''minimal''. The term ''minimal encephalopathy'' (MHE) is defined by patients with cirrhosis who do not demonstrate clinically overt cognitive dysfunction, but who show a cognitive impairment on neuropsychological studies.<ref name=Ferenci/> This is still an important finding, as minimal encephalopathy has been demonstrated to increase the rate of road traffic accidents and violations.<ref>{{cite journal |author=Bajaj JS, Hafeezullah M, Hoffmann RG, Saeian K |title=Minimal hepatic encephalopathy: a vehicle for accidents and traffic violations |journal=Am J Gastroenterol |volume=102 |issue=9 |pages=1903–09 |year=2007 |pmid=17640323 |doi=10.1111/j.1572-0241.2007.01424.x}}</ref>
=== Based on underlying liver disease ===
According to world congress of [[gastroenterology]], hepatic encephalopathy can be subdivided based on underlying [[liver disease]] association into type A, B, and C<ref name="Conn" /><ref name="pmid11870389" /><ref name="pmid24411831">{{cite journal| author=Leise MD, Poterucha JJ, Kamath PS, Kim WR| title=Management of hepatic encephalopathy in the hospital. | journal=Mayo Clin Proc | year= 2014 | volume= 89 | issue= 2 | pages= 241-53 | pmid=24411831 | doi=10.1016/j.mayocp.2013.11.009 | pmc=4128786 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24411831  }} </ref>
* '''Type A (acute):''' Describes hepatic [[encephalopathy]] associated with acute [[liver]] failure
* '''Type B (bypass):''' Is caused by [[Portacaval shunt|portal-systemic shunt<nowiki/>ing]] without associated intrinsic [[liver]] disease
* '''Type C ([[cirrhosis]]):''' Occurs in patients with [[cirrhosis]] ([[chronic liver disease]])
 
=== Based on duration and characteristics of hepatic encephalopathy ===
Based on the duration and characteristics of hepatic [[encephalopathy]], it can be classified into episodic, persistent, and minimal<ref name="pmid19707277">{{cite journal| author=Al Sibae MR, McGuire BM| title=Current trends in the treatment of hepatic encephalopathy. | journal=Ther Clin Risk Manag | year= 2009 | volume= 5 | issue= 3 | pages= 617-26 | pmid=19707277 | doi= | pmc=2724191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19707277  }} </ref>
* '''Episodic hepatic [['|encephalopathy]]:''' Has a short time span and fluctuates in severity
* '''Persistent hepatic encephalopathy:''' Occurs as a chronic clinical condition of [[Cognitive deficit|cognitive deficits]]
* '''Minimal hepatic encephalopathy''' '''(MHE)''': Occurs in patients with [[cirrhosis]] who do not demonstrate clinically overt [[cognitive]] dysfunction, but who show a [[cognitive impairment]] on [[Neuropsychological|neuropsychologica]]<nowiki/>l studies<ref>{{cite journal |author=Bajaj JS, Hafeezullah M, Hoffmann RG, Saeian K |title=Minimal hepatic encephalopathy: a vehicle for accidents and traffic violations |journal=Am J Gastroenterol |volume=102 |issue=9 |pages=1903–09 |year=2007 |pmid=17640323 |doi=10.1111/j.1572-0241.2007.01424.x}}</ref><ref name="pmid23006457">{{cite journal| author=Bleibel W, Al-Osaimi AM| title=Hepatic encephalopathy. | journal=Saudi J Gastroenterol | year= 2012 | volume= 18 | issue= 5 | pages= 301-9 | pmid=23006457 | doi=10.4103/1319-3767.101123 | pmc=3500018 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23006457  }} </ref>
 
===Based on severity of the disease===
The evaluation of severity of persistent hepatic [[encephalopathy]] is based on the West Haven Criteria.<ref name="pmid11870389">{{cite journal| author=Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT| title=Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. | journal=Hepatology | year= 2002 | volume= 35 | issue= 3 | pages= 716-21 | pmid=11870389 | doi=10.1053/jhep.2002.31250 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11870389  }} </ref><ref name="Conn">Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology 1977; 72: 573-83.</ref>


==Grading==
'''West Haven Criteria'''
The evaluation of severity of persistent hepatic encephalopathy is based on the West Haven Criteria for semi-quantitative grading of mental status, referring to the level of impairment of autonomy, changes in consciousness, intellectual function, behavior, and the dependence on therapy.<ref name=Ferenci/><ref name=Conn>Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. ''Gastroenterology'' 1977; 72: 573-83.</ref>.
* '''Grade 1:'''
* Grade 1 - Trivial lack of awareness; Euphoria or anxiety; Shortened attention span; Impaired performance of addition. 67% of cirrhotic patients may have 'minimal hepatic encephalopathy'.<ref name="pmid17326150">{{cite journal |author=Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R |title=Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy |journal=Hepatology |volume=45 |issue=3 |pages=549-59 |year=2007 |pmid=17326150 |doi=10.1002/hep.21533}}</ref>
**Trivial lack of awareness
* Grade 2 - Lethargy or [[apathy]]; Minimal disorientation for time or place; Subtle personality change; Inappropriate behavior; Impaired performance of subtraction
**Euphoria or [[anxiety]]
* Grade 3 - [[Somnolence]] to semi[[stupor]], but responsive to verbal stimuli; Confusion; Gross disorientation
**Short [[attention span]]
* Grade 4 - [[Coma]] (unresponsive to verbal or noxious stimuli)
**67% of [[Cirrhosis|cirrhotic]] patients may have minimal hepatic encephalopathy<ref name="pmid17326150">{{cite journal |author=Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R |title=Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy |journal=Hepatology |volume=45 |issue=3 |pages=549-59 |year=2007 |pmid=17326150 |doi=10.1002/hep.21533}}</ref>
 
* '''Grade 2:'''
**[[Lethargy]] or [[apathy]]
**Minimal [[disorientation]] to time or place
**Subtle [[Personality changes|personality change]]
**Impaired performance in doing mathematical problems (specially subtraction)
* '''Grade 3:'''
**[[Somnolence]] to semi-stupor, but responsive to verbal stimuli
**[[Confusion]]
**Gross [[disorientation]]
* '''Grade 4:'''
**[[Coma]] (unresponsive to verbal or [[noxious]] stimuli)


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
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Latest revision as of 18:05, 24 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Hepatic encephalopathy may be classified based on underlying liver disease into three types type A (acute), Type B (bypass) and type C (cirrhosis). The evaluation of severity of persistent hepatic encephalopathy is based on the West Haven Criteria. It includes mental status, level of impairment of autonomy, changes in consciousness, intellectual function, behavior, and the dependence on therapeutic factors into grading.

Classification

Based on underlying liver disease

According to world congress of gastroenterology, hepatic encephalopathy can be subdivided based on underlying liver disease association into type A, B, and C[1][2][3]

Based on duration and characteristics of hepatic encephalopathy

Based on the duration and characteristics of hepatic encephalopathy, it can be classified into episodic, persistent, and minimal[4]

Based on severity of the disease

The evaluation of severity of persistent hepatic encephalopathy is based on the West Haven Criteria.[2][1]

West Haven Criteria

References

  1. ↑ 1.0 1.1 Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology 1977; 72: 573-83.
  2. ↑ 2.0 2.1 Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002). "Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998". Hepatology. 35 (3): 716–21. doi:10.1053/jhep.2002.31250. PMID 11870389.
  3. ↑ Leise MD, Poterucha JJ, Kamath PS, Kim WR (2014). "Management of hepatic encephalopathy in the hospital". Mayo Clin Proc. 89 (2): 241–53. doi:10.1016/j.mayocp.2013.11.009. PMC 4128786. PMID 24411831.
  4. ↑ Al Sibae MR, McGuire BM (2009). "Current trends in the treatment of hepatic encephalopathy". Ther Clin Risk Manag. 5 (3): 617–26. PMC 2724191. PMID 19707277.
  5. ↑ Bajaj JS, Hafeezullah M, Hoffmann RG, Saeian K (2007). "Minimal hepatic encephalopathy: a vehicle for accidents and traffic violations". Am J Gastroenterol. 102 (9): 1903–09. doi:10.1111/j.1572-0241.2007.01424.x. PMID 17640323.
  6. ↑ Bleibel W, Al-Osaimi AM (2012). "Hepatic encephalopathy". Saudi J Gastroenterol. 18 (5): 301–9. doi:10.4103/1319-3767.101123. PMC 3500018. PMID 23006457.
  7. ↑ Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R (2007). "Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy". Hepatology. 45 (3): 549–59. doi:10.1002/hep.21533. PMID 17326150.

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