Hepatic encephalopathy differential diagnosis

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

Overview

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Differentiating X from other Diseases

• Hepatic encephalopathy must be differentiated from other diseases that cause personality changes, altered level of consciousness and jerking movement of the limbs(asterixis) such as, complicated alcohol withdrawal, Wernicke encephalopathy, alcohol intoxication, metabolic abnormalities(hypoglycemia, electrolyte imbalance, hypercarbia, and uremia) ,toxic encephalopathy from drugs(sedative, salicylates, antidepressants and antipsychotic drugs), altered intracranial pressure(intracranial tumors, ,subdural hematoma, intracranial bleeding and abscesses), intoxication by chemical agents, malnutrition, hypoxia of brain, and sever intracranial or systemic infections(meningitis and encephalitis).

Preferred Table

Normalization of speech, improved response times, resolution of asterixis, and improved handwriting skills are examples of exam findings that support improvement. 

Diseases	History and Symptoms			Physical Examination				Laboratory Findings				Other Findings
	Personality changes	Altered level of consciousness	Jerking movement of the limbs(asterixis)	Slurred speech	Writing disturbances	Voice monotonous	Impaired memory	Lab Test 1	Lab Test 2	Lab Test 3	Lab Test 4
Hepatic encephalopathy	++	++	++	++	++	++	++
alcohol intoxication	+	+	-/+	++	+	-	+
Alcohol withdrawal	+	+	-	++	+	-	+
Uremia	++	++	+	-/+	-/+	-/+
Wernicke encephalopathy	+	+	-/+	+	+	+	++
Toxic encephalopathy from drugs	+	+	-/+	-/+	+	-/+	+
Altered intracranial pressure	+	-/+	-	-/+	-/+	-	-/+
Intoxication by chemical agents	-/+	-/+	-/+	-/+	-/+	-	-
Malnutrition	-/+	-	-	-	-/+	-	-/+
Hypoxia of brain	-	-/+	-	-/+	-/+	-/+	-/+
Meningitis and encephalitis	-/+	-/+	-	-/+	+	-	-
Hypoglycemia	-/+	-/+	-	-/+	-/+	-	-

Use if the above table can not be made

Differential Diagnosis	Similar Features	Differentiating Features
Differential 1	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].