Pathophysiology and management of hepatic encephalopathy

Hepatic encephalopathy is a common complication of liver cirrhosis occurring in up to 80% of patients and is characterized by neuropsychiatric complications ranging from slight altered mental status to coma. While the underlying mechanisms remain poorly understood with several proposed hypothesized theories, the mainstays of treatments are aimed at identifying and treating the precipitating causes or reducing intestinal ammonia production. Despite the increasing incidence of liver disease and liver cirrhosis within the UK, there have been few major advances in treatments of hepatic encephalopathy over the last decade. This article provides an overview of the pathogenesis, and medical and surgical management of this major clinical problem.