[Portosystemic encephalopathy]

Hepatic encephalopathy is still today a diagnostic and treatment challenge for any clinician, distinguishing two types: that occurring in patients with acute liver disease and that associated with chronic liver disease. Despite our limited understanding of the pathogenesis of this disorder, treatment for hepatic encephalopathy in patients with chronic liver disease is reasonable satisfactory. Identification and treatment of precipitating factors and lactulose and lactitol therapy, still remain the most important aspects of management. In our country, we have used lactose, a natural disacharide, with the same good results gotten with the synthetic disacharide. Hepatic transplantation has become a realistic therapeutic option in the management of patients with intractable hepatic encephalopathy and is the only effective treatment for hepatic encephalopathy associated with fulminant hepatic failure.