hepatic and biliary disorders
Portosystemic Encephalopathy
Key Points
Portosystemic encephalopathy is a neuropsychiatric syndrome that occurs when portosystemic shunting allows absorbed products that are normally detoxified by the liver to reach the brain. Manifestations include cognitive and behavioral dysfunction (eg, confusion, obtundation, coma) and neuromuscular dysfunction (eg, flapping tremor, ataxia, hyperreflexia or hyporeflexia). Diagnose portosystemic encephalopathy based mainly on clinical findings, but usually measure the blood ammonia level, and if signs are subtle or absent, do neuropsychologic testing. Exclude other treatable disorders (eg, subdural hematoma, hypoglycemia, intoxication), and search for triggers of encephalopathy (eg, infection, gastrointestinal bleeding, electrolyte abnormality). Treat the cause of encephalopathy and treat encephalopathy itself with bowel cleansing (using oral or rectallactuloseor oralpolyethylene glycol3350 or enemas) and oralrifaximinorneomycin. 