Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles

Area of Science:

• Hepatology
• Neurology
• Gastroenterology

Background:

• Hepatic encephalopathy (HE) is brain dysfunction caused by liver insufficiency or portal-systemic shunting.
• Type C HE specifically refers to HE in patients with liver cirrhosis.
• Manifestations range from subclinical neurological/psychiatric changes to coma.

Purpose of the Study:

• To review hepatic encephalopathy (HE) in liver cirrhosis patients.
• To discuss diagnostic criteria and grading scales for HE.
• To highlight challenges in diagnosing HE due to non-specific symptoms.

Main Methods:

• Review of literature on hepatic encephalopathy in liver cirrhosis.
• Discussion of diagnostic scales, including the West Haven criteria (WHC).
• Exploration of minimal hepatic encephalopathy (MHE) and its classification.

Main Results:

• HE presents a spectrum of neurological and psychiatric abnormalities in cirrhosis.
• The West Haven criteria (WHC) are commonly used for grading overt HE.
• Minimal hepatic encephalopathy (MHE) involves brain dysfunction without overt symptoms.

Conclusions:

• Diagnosis of HE and MHE requires excluding other causes of brain dysfunction.
• Covert HE (MHE + WHC Grade I) and overt HE (WHC Grades II-IV) are proposed classifications.
• Non-specific symptoms complicate HE diagnosis, necessitating differential diagnosis.