- Also called as the portosystemic

encephalopathy, it is a life-
threatening complication of liver
disease that occurs with profound
liver failure.
 Reversible metabolic form of
encephalopathy can improve with the
recovery of liver function
Onset is often insidious and subtle
The disease is termed as subclinical or
minimal hepatic encephalopathy
 Hepatic encephalopathy (HE) is a
syndrome of neuropsychiatric
dysfunction caused by portosystemic
venous shunting, with or without intrinsic
liver disease. Clinicians diagnosing HE
frequently have the opportunity to
intervene and reverse severe HE, even
hepatic coma.
 Patients with HE often have other
manifestations of end-stage liver disease,
such as ascites, jaundice, or
gastrointestinal variceal bleeding. HE can
also develop as an isolated manifestation
of decompensated cirrhosis.
Earliest Symptom
Mental status changes
Motor disturbances changes
Patient appears confused and unkempt
Has alterations in mood and sleep
patterns
STAGE CLINICAL SYMPTOMS CLINICAL SIGNS

1 Normal level of consciousness with Asterixis

periods of lethargy and euphoria
Reversal of day-night patterns
2 Increased drowsiness
Disorientation
Inappropriate behavior
Mood swings
Agitation
3 Stuporous
Difficult to rouse
Sleeps most of time
Marked confusion
Incoherent speech
4 Comatose
May not respond to painful stimuli
Impaired writing and ability to draw line
figures.
Asterixis
Fetor hepaticus
Asterixis
Increase deep tendon reflexes
Rigidity of extremities
Absence of asterixis
Absence of deep tendon reflexes
Flaccidity of extremities
 Diagnosis is clinical based on the
presence of cirrhosis or portosystemic
shunt with symptoms of encephalopathy
Rare alternate diagnoses include
meningitis, infectious encephalitis,
Wernicke's encephalopathy and Wilson
disease
o Lactulose is administered to reduce serum ammonia levels.
o Patient is closely monitored for hypokalemia and dehydration.
o IV administration of glucose to minimize protein breakdown.
o Administration of vitamins to correct deficiencies.
o Antibiotics may also be added to the treatment regimen.
o Neurologic status is assessed frequently.
o Mental status is monitored by keeping a daily record of hand
writing and arithmetic performance.
o I&O and body weight are recorded each day.
o Vital signs are recorded every 4 hrs.
o Potential sites of infection (peritoneum, lungs) are assess
frequently and abnormal findings are reported promptly.
o Serum ammonia level is monitored daily.
o Protein intake is moderately restricted only in patients who
are comatose or who have encephalopathy that is
refractory to lactulose and antibiotic therapy
o Patient and family are advised about foods that are high
in proteins which may need to be limited in the diet for the
short term to reduce production of ammonia.
o Enteral feeding is provided for patients whose
encephalopathic state persist.
o Reduction in the absorption of ammonia from the
GI tract is accomplished by the use of gastric
suction, enemas or oral antibiotics.
o Electrolyte status is monitored and corrected if
abnormal.
o Sedatives, tranquilizers and analgesics medication
are discontinued.
o Benzodiazepine antagonists such as flumazenil
may be administered to improved
encephalopathy.
o Maintain safe environment to prevent injury, bleeding and
infection.
o Administer prescribed treatments and monitors patient for
the numerous potential complications.
o Encourage deep breathing and position changes to prevent
atelectasis, pneumonia and other respiratory complications.
o Communicate with patients family to inform them about the
patients status and supports them by explaining the
procedures and treatments that are part of the patients care.
o Educate patient about self care
o Assess patients physical and mental status and collaborate
closely with the primary provider.
o Home visit
o Evaluate patients fluid volume status and be alert for changes
indicative of hypovolemia due to decrease intake and for
decrease urine output.
o Monitoring of laboratory values continues to be important
and the home nurse must obtain prescriptions to correct
abnormalities, especially electrolyte imbalances which also can
worsen encephalopathy.
o Assess safety of home environment.
o Reminds the patient and family about the importance of
dietary restrictions, close monitoring and follow-up.
o Observe patient for subtle behavior changes of worsening
hepatic encephalopathy.