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Diagnosis and Treatment of Hepatic Encephalopathy.

JB Hepatic encephalopathy (HE) is a neuropsychiatric abnormality in patients who have a liver disease such as cirrhosis or in those with portosystemic shunting. HE ranges from subclinical manifestations all the way to coma. HE that is clinically apparent is referred to as overt HE, whereas HE that is difficult to define clinically is referred to as covert HE. Patients with covert HE can be completely asymptomatic and can have cognitive impairment. Covert HE includes patients with prior Grade 1 HE and those with minimal HE. Patients with minimal HE usually have never had overt HE before and currently do not have any type of behavioral problems, but when these patients undergo diagnostic testing, they have abnormal results compared with healthy controls who are ageand sex-matched but do not have cirrhosis. Grade 1 HE is difficult to diagnose unless the patient is being followed carefully. Patients with Grade 1 HE have some behavioral or sleep abnormalities, but are not disoriented and have no asterixis. Patients who are disoriented and/ or have asterixis have Grade 2 HE and beyond, which is currently considered overt HE.