Pathophysiology and Treatment of Hepatic Encephalopathy

Hepatic encephalopathy is a neurologic syndrome caused by hepatic insufficiency or portosystemic shunting, leading to the accumulation of ammonia and other neurotoxins. Clinical signs range from subtle behavioral changes to seizures and recumbency. Diagnosis relies on neurologic signs together with laboratory evidence of liver dysfunction, imaging, and sometimes biopsy. Importantly, hyperammonemia may occur without underlying hepatic dysfunction. Treatment focuses on addressing the underlying hepatic disease, reducing ammonia production and absorption, managing inflammation and cerebral edema, and providing supportive care. Prognosis varies widely and depends primarily on the underlying etiology, severity of hepatic damage, and response to therapy.